Incidence and clinical relevance of persistent iatrogenic atrial septal defect after percutaneous mitral valve repair

Mhd Nawar Alachkar,Ertunc Altiok,Jörg Schröder,Sebastain Reith,Nikolaus Marx,Anas Alnaimi,Mohammad Almalla

doi:10.1038/s41598-021-92255-3

Abstract

Percutaneous mitral valve repair (PMVR) requires transseptal puncture and results in iatrogenic atrial septal defect (iASD). The impact of persistent iASD was previously investigated. However, data were diverse and inconclusive. 53 patients who underwent MITRACLIP were retrospectively included. Based on the presence of iASD in transesophageal echocardiography (TEE) after 6 months, patients were divided in two groups (iASD group vs. non-iASD group). Impact of iASD on outcome at 6 months and at two years was evaluated. Persistent iASD was detected in 62% of patients. Independent predictors for persistent iASD were female gender and reduced left ventricular ejection fraction. At 6-month follow-up, there was no difference in reduction of NYHA class (ΔNYHA = 1.3 ± 1 in iASD group vs. 0.9 ± 1 in non-iASD group, p = 0.171). There was a significant difference in right ventricular end diastolic diameter (RVEDd) (42 ± 8 mm in iASD-group vs. 39 ± 4 mm in non-iASD group, p = 0.047). However, right ventricular systolic function (TAPSE) (14 ± 7 mm in iASD group vs. 16 ± 8 mm in non-iASD group, p = 0.176) and right ventricular systolic pressure (RVSP) (40 ± 12 mmHg in iASD group vs. 35 ± 10 mmHg in non-iASD group, p = 0.136) were still comparable between both groups. At 2 years follow-up, there was no significant difference regarding rate of rehospitalization (24% vs 15%, p = 0.425) or mortality (12% vs 10%, p = 0.941) between both groups. Incidence of persistent iASD after MITRACLIP is markedly high. Despite the increase in right ventricular diameter in patients with persistent iASD, these patients were not clinically compromised compared to patients without persistent iASD.

Highlights

Percutaneous mitral valve repair (PMVR) requires transseptal puncture and results in iatrogenic atrial septal defect
Univariate logistic regression analysis of patients’ characteristics mentioned in Table 2 showed that female gender (OR = 5.4, 95% CI 1.48–19.82, p = 0.010) and reduced left ventricular ejection fraction (LV-EF) (OR = 0.95, 95% CI 0.91–0.99, p = 0.031) were associated with persistent iatrogenic atrial septal defect (iASD) at 6-months follow-up
The main findings of this study were: (1) Incidence of persistent iASD at 6 months follow-up after MITRACLIP procedure was high and found to be 62%. (2) Persistence of iASD causes volume overload on the right heart without affecting its function or right ventricular systolic pressure (RVSP). (3) Persistent iASD had no impact on clinical outcome at 6 months or at the rate of rehospitalization or mortality at 2-years follow up. (4) Independent predictors for persistence iASD were female gender and reduced LVEF

Summary

Methods

Patients who presented to the predetermined elective follow-up appointment at our center with clinical interview and echocardiographic examinations with transesophageal echocardiography (TEE) at 6 months were retrospectively included (n = 53). Patients who received their followup in the referring hospitals were not considered. All included patients received an echocardiographic follow-up with TTE and TEE at 6 months. Pre- and post-interventional clinical and echocardiographic parameters in each group (Intragroup comparison) were performed using T-test for paired samples for continuous variables and the Wilcoxon-signed rank test for ordinal variables (NYHA class, severity of MR and tricuspid regurgitation (TR).

Results

Discussion

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Conclusions