title: Mitral annular motion in patients after transcatheter MitraClip and mitral valve surgery.
abstract: BACKGROUND
  Longitudinal motion of the mitral annulus is an index that reflects left ventricular (LV) function. The aim of this study was to evaluate and compare the effects of transcatheter mitral valve (MV) repair and open heart surgery for mitral regurgitation (MR) on mitral annular motion (MAM).
  
  
  METHODS
  We retrospectively analyzed in total 115 patients who underwent isolated transcatheter MV repair using MitraClip (n=50) or surgical MV interventions (n=65, 50 repairs and 15 replacements) for MR. MAM was assessed by two-dimensional B-mode echocardiography in the four- and two-chamber views. MAM was measured before and within 1 month after the mitral procedure.
  
  
  RESULTS
  Compared with patients undergoing MV surgery, patients undergoing the MitraClip procedure were older and had more comorbidities. MR grade improved significantly in both groups after MV intervention. MAM decreased significantly in the surgery group (12.0±3.1 to 8.1±2.2 mm, P<.01), whereas MAM did not change in the MitraClip group (8.8±2.6 to 8.6±2.5 mm, P=.59). In multivariate analysis, mitral surgery was associated with a decrease in MAM when compared to the MitraClip procedure. Furthermore, LV ejection fraction (EF) decreased to a greater degree in patients undergoing surgery than those undergoing MitraClip placement (MV surgery; -10.1±7.6% vs MitraClip; -3.0±10.5%, P<.01).
  
  
  CONCLUSIONS
  MitraClip therapy does not adversely influence MAM and is associated with less postprocedural EF reduction compared to surgical intervention. Our results suggest that patients with reduced LV systolic function may benefit from the MitraClip procedure compared to mitral surgery.
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Kentaro
authors.identifier: http://orcid.org/0000-0002-7083-0371
authors.initials: K
authors.lastname: Toyama
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Florian
authors.initials: F
authors.lastname: Rader
authors.affiliation: Department of Anesthesia, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Kengo
authors.initials: K
authors.lastname: Ayabe
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Trento
authors.affiliation: Department of Cardiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Nishioka
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Michele A
authors.initials: MA
authors.lastname: De Robertis
authors.affiliation: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
keywords: mitral regurgitation; mitral valve repair