title: Impact of interventional edge-to-edge repair on mitral valve geometry.
abstract: OBJECTIVE
  The acute and long-term effects of interventional edge-to-edge repair on the mitral valve (MV) geometry are unclear. We sought to assess MV-annular geometry and the association of changes in MV-diameters with functional response one year after MitraClip implantation.
  
  
  METHODS
  Consecutive patients (n=84; age 81.2±8.3years, logistic EuroSCORE 21.7±17.9%) with symptomatic moderate-to-severe mitral regurgitation (MR) underwent MitraClip-procedure. MV-annular geometry was assessed with 3D TOE before, immediately and one year after clip implantation.
  
  
  RESULTS
  96.7% of secondary mitral regurgitation (SMR) patients presented with moderate-to-severe MR, 3.3% with severe SMR, respectively. 66.7% of primary MR (PMR) patients had moderate-to-severe MR, and 33.3% severe PMR respectively. When analyzing immediate effects of MitraClipC on mitral geometry, only patients with SMR (n=60, 71.4%) experienced significant reductions of the diastolic MV anterior-posterior diameters (AP: 3.9±0.5cm, 3.5±0.7cm; p<0.001), and annulus-areas (2D: 12.9±3.8cm2, 12.6±3.7cm2; p<0.001; 3D: 13.4±3.8, 13.1±3.2cm2; p<0.001). All measures on MV annular geometry were not significantly altered in patients with PMR (p>0.05). After one year of follow-up, MV annular parameters remained significantly reduced in SMR patients (p<0.05) and remained unchanged in subjects with PMR (p>0.05). Only SMR patients experienced significant increase in 6min walking distances (p=0.004), decrease in pulmonary pressures (p=0.007) and functional NYHA-class (p<0.001); in patients with PMR only NYHA class improved after one year (p<0.001).
  
  
  CONCLUSIONS
  Edge-to-edge repair with the MitraClip-system impacts on MV-geometry in patients with SMR with stable results after 12months. Reduction of MV-annular dimensions was associated with higher rates of persisting MR reduction and better functional status in patients with SMR.
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany. Electronic address: Robert.schueler@ukb.uni-bonn.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Schueler
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kaplan
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Melzer
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Can
authors.initials: C
authors.lastname: Öztürk
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Weber
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Jan-Malte
authors.initials: JM
authors.lastname: Sinning
authors.affiliation: Department of Cardiovascular Surgery, Heart Centre Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Nikos
authors.initials: N
authors.lastname: Werner
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.affiliation: Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hammerstingl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: 3D echocardiography; MitraClip; Mitral regurgitation; Mitral valve geometry