Abstract 14797: Impact of Normalized Pulmonary Vein Flow Pattern After Percutaneous Mitral Valve Repair

Abstract

Background: Systolic reverse pulmonary venous flow (PVF) assessed with pulsed Doppler echocardiography is a valuable marker of severe mitral regurgitation (MR). However, the relationship between PVF pattern after MR reduction by percutaneous mitral valve repair with MitraClip system and clinical outcome is not well established. We hypothesized that normalized PVF after MitraClip procedure was associated with successful MR reduction and clinical outcome. Method: 146 consecutive patients with symptomatic MR who implanted the MitraClip were studied. The patients were divided into 2 groups on the basis of post-procedural left upper PVF pattern; the normalized group (n = 77) and the non-normalized group (n = 69). The normalized PVF was defined as a ratio of peak systolic to diastolic flow velocity ≧1. Results: In baseline characteristics, the normalized PVF was independently associated with age <75 (liner regression coefficient [B] = 0.521, 95% confidence interval [CI] = 0.146 - 0.822, P = 0.016) and degenerative MR (B = 0.969, 95% CI 0.049 - 0.383, P <.0001). The normalized group demonstrated significantly higher residual MR ≦2 rate than non-normalized group (100% vs. 97.3%, P = 0.003). At a mean of 2.9 ± 1.9 years follow up, the rate of freedom from the composite endpoint (defined as surgery or 2nd MitraClip procedure for mitral valve dysfunction or all cause death) was significantly higher in the normalized group. Mutivariable Cox regression analysis demonstrated that normalized PVF was an independent post-procedural parameter of freedom from composite endpoint (hazard ratio =0.571, 95%CI 0.339 - 0.948, P = 0.03). Conclusion: The normalized PVF after the MitraClip procedure was associated with successful MR reduction and a long-term clinical outcome. Prospective data should be used to validate this.