Abstract 13691: Right Ventricular Remodeling Post MitraClip Insertion for Severe Mitral Regurgitation - Single Centre Echocardiographic Study

Abstract

Introduction: Percutaneous mitral valve repair (Mitraclip) has expanded treatment options for high risk surgical patients with severe mitral regurgitation (MR). Hypothesis: The impact of amelioration of MR by Mitraclip on right ventricular (RV) remodeling and the pulmonary vasculature has received limited investigation. Methods: We undertook a prospective evaluation of consecutive patients who underwent Mitraclip insertion at our centre. Transthoracic echocardiograms were performed pre Mitraclip, 1 day, 1 month, 6 months and 12 months post Mitraclip procedure. We assessed right ventricular (RV) size, fractional area change (FAC), Myocardial performance index (MPI), right atrial (RA) area, left ventricular ejection fraction (LVEF), and estimated pulmonary artery systolic pressure (PASP) from the tricuspid regurgitant spectral Doppler signal according to published ASE guidelines. Results: Twenty-nine patients underwent Mitraclip procedure from March 2011 to June 2013. Six patients were excluded from 12 month analysis because of incomplete data (2 patients), insertion of a LV assist device (1), and mortality (3), Among the 23 study patients, mean age was 73 y (range 52 to 85). The following table shows the mean values and standard errors with significant differences indicated in * (p<0.05), ** (p<0.01) Linear mixed effects models were used to compare pre treatment measurements with post treatment measurements. Conclusion: Right ventricular function by FAC and MPI improved post Mitraclip. Pulmonary artery pressures also improved although the benefit appeared limited to 6 months post procedure. We observed no clear change in other parameters of right heart function or chamber size. Larger long term studies are required to evaluate these results.