Usefulness of pulmonary vein flow as a predictor of long-term mortality after MitraClip implantation

Abstract

Abstract Background Severe mitral regurgitation (MR) is a common valvular heart disease that has an unfavorable prognosis. Percutaneous mitral valve (MV) repair has become an effective therapeutic alternative to MV surgery in high-risk surgical patients with moderate to severe MR. Pulsed Doppler evaluation of pulmonary venous (PV) flow is widely used to aid in the assessment of grading the severity of MR and it has been recently investigated in patients who underwent MitraClip placement. Purpose The purpose of this study is to evaluate the usefulness of pulmonary vein flow as a predictor of long-term mortality after MitraClip implantation. Methods This is a single-center, retrospective study in which, between 2010 and 2020, we enrolled 88 consecutive patients who underwent percutaneous MV repair with the MitraClip system, afferent to our tertiary university hospital, eligibility evaluation by TEE. All patients had moderate to severe (3+) or severe (4+) primary or secondary MR. We excluded patients with re-do MitraClip procedure (n=1), no medical record (n=2), no or insufficient PV flow record (n=20). We analyzed the MR and PV flow parameters, such as systolic/diastolic velocity time integral (VTIs/VTId) and maximum velocity (VmaxS/VmaxD) ratios,before and immediately after the procedure. Results 65 patients (35% women) with a median age of 76.2 ± years (10.4 years). Average follow-up 13 months (1–28). In survivors the ratio of VTIs/VTId post was higher than in the deceased (1.14±0.60 vs 0.56±0.21; p=0.039). Same results were found considering post-procedure VmaxS/VmaxD ratio, with greater values among the survivors compared with patients who died during the follow up (1.17±0.44 vs 0.65±0.09; p<0.001). The ROC curve of the post procedure VTIs/VTId ratio to predict mortality had an area under the curve of 0.82, while for the post VmaxS/VmaxD ratio it was 0.94. Conclusion VTIs/VTId and the VmaxS/VmaxD ratio in PV flow after the procedure appeared as potential parameters to predict long-term mortality in patients who receive MitraClip implants Funding Acknowledgement Type of funding sources: None. Figure 1. ROC curve VTIs/VTId ratio for survival.Figure 2. ROC curve VmaxS/VmaxD ratio for survival.