MitraClip Research Articles

Abstract 13923: Incidence and Outcomes of Infective Endocarditis After 180 Days in Transcatheter Aortic Valve Replacement and Mitraclip

Background: Infective endocarditis (IE) after Transcatheter aortic valve replacement (TAVR) and Mitra Clip (MC) occurs less commonly but is associated with grave complications. We aim to report the incidence and outcomes of IE within 180 days of TAVR and MC. Methods: We used the Nationwide Readmissions Database (NRD) between 2014 and 2017 to select patients who underwent either TAVR or MC between January and June every year (to allow for at least 180 days of follow up in the NRD) using the appropriate International Classification of Diseases-9 th and 10 th revision (ICD) codes. We performed a chi-square test to compare baseline characteristics and rates of IE after TAVR and MC procedures. All statistical analyses were performed the using SPSS version 26. Results: We included 68,270 and 7,080 patients who underwent TAVR and MC respectively, of which 0.68% vs. 0.94% (P=.012), developed IE respectively within 180 days of procedure. During that index hospitalization, in-hospital mortality rates did not differ between the two groups (15.08% in TAVR vs. 17.91%, in MC P=.587). Other outcomes are presented in table 1. Conclusion: Our study suggests that the overall incidence of IE following TAVR and MC is relatively low but appropriate preventive measures should be taken after the procedures to reduce the morbidity and mortality. Further studies and analysis are required in modern MC and TAVR techniques to circumvent this critical complication.

Doppler echocardiographic predictors of low mitral valve area after implantation of one MitraClip: time for a paradigm shift?

Abstract Introduction During edge-to-edge therapy using MitraClip (MC) for severe mitral regurgitation (MR) the interventional cardiologists usually rely on the mean transmitral gradient to decide if they “go for” a second clip in case of suboptimal MR reduction or to stabilise the first MC in the context of prolapse or flail leaflet. The value of this parameter to detect low mitral valve area (MVA) is unknown. Method During each intervention of the last two years, high quality volumes focused on the MV were acquired. Using a dedicated 3-D analysis software and a new planimetry method, we measured the MVA before and after the implantation of one MC (each orifice was evaluate independently on the most optimal plane). The usual transmitral CW-Doppler parameters (mean gradient (MG), VTI, PHT) were evaluated. Results We included 120 patients, 69 primary (PMR) and 51 secondary (SMR) mitral regurgitation. For all the parameters, the best model for the curve fitting was y = a + b / x and the two parameters who best correlated with the MVA after MC were PHT (R2 0.67, p=0.0001) and MG (R2 0.28, p. 0001). Looking at SMR, the correlation with PHT was even better but there was no correlation with MG. In PMR, the correlation with MG was good but still lower than with PHT (Figure 1). The ROC analysis for PHT showed an AUC of 0.948 and defined an optimal cut-off of 127ms with sensibility and specificity 91% to detect a MVA <2 cm2 after one MC. Conclusion The transmitral MG appears as a poor parameter to predict low MVA after the implantation of one MC, especially in SMR probably because in this population the MG depends more on the flow than on the MVA. In the contrary PHT appears as a robust parameter. Figure 1 Funding Acknowledgement Type of funding source: None

Impact of intervention strategies after failed Mitraclip therapy on mid-term outcome

Abstract Introduction Procedural failure after MitraClip (MC) therapy has a decisive prognostic influence and Re-treatment after acute procedure failure (APF) remains complex due to the generally high-risk patients. The aim of this work is to analyze the mid-term outcome between the surgical and the percutaneous interventional treatment routes according to APF from our High Volume Center. Methods Retrospective analysis of patients (pts.) consecutively treated with MC in the period from 9/2009 - 5/2019 with residual mitral regurgitation (rMR) that is still higher in the case of symptomatic APF (NYHA 3–4). Outcome analysis in primary (PMR) and secondary MR (SMR) with subsequent percutaneous (group Reclip) vs. surgical treatment (group surgery). Results Of a total of 824 pts., 63 (73±10 years, 20 women [31,7%]) showed APF (MR>2) peri / postinterventionally. Mitraclip reintervention was performed in 36 pts. (26 SMR, 10 PMR), while 27 (13 SMR, 14 PMR) underwent surgery. Mitral valve replacement (MVR) was surgically performed on 21 pts. (11 PMR, 10 SMR), while reconstruction (MVrec) was performed on n=6 (3 PMR, 3 SMR). The mechanism of the rMR in the surgery group, n=14 (51.9%) was a pure sail injury (LT) or a partial clip detachment (PCD) or a combination of both, n=9 (33.3%) a severe rMI, n=3 (11.1%) device endocarditis and n=1 (3.7%) a technical device problem. In the reclip group n=15 (41.7%) showed an LT and / or a PCD and n=21 (58.3%) a severe rMR. Thirty-day mortality was 13.9% (n=5 deaths) in the ReClip-group (n=4 SMR, n=1 PMR) an 18.5% in the surgical group (n=5 deaths; all SMR patients). In the midterm FU over 18 months (Figure 1), the surgically treated patients with SMR showed a significantly higher mortality rate than in patients with PMR (p=0.002). In the Reclip intervention group, no significant difference between treated PMR and SMR patients can be objectified (p=0.995). The comparison between surgery / reclip in the PMR group shows no significance, whereas a trend (p=0.148) in favor of the reclip can be distinguished between surgery / reclip in SMR in the outcome. Conclusion Surgically treated patients after AFP with an SMR as index etiology show a very poor short and medium-term survival both in comparison to the PMR patients and to the two reclip groups. With the combination of AFP and SMR, the reclip treatment can be regarded as the primary treatment option despite the lack of statistical significance compared to surgery. In return, surgery combined with AFP and PMR offers a viable alternative and can be favored over the reclip procedure in younger patients. Kaplan-Meier plot of the 4 intervention groups Funding Acknowledgement Type of funding source: None

MitraClip implantation followed by insertion of a left ventricular assist device in patients with advanced heart failure.

AimsMitral valve regurgitation (MR) is common in patients with advanced heart failure (HF). Percutaneous mitral valve repair (PMVR) via MitraClip (MC) has emerged as a feasible treatment strategy for these high‐risk patients. However, as HF often further progresses, there is a frequent need for left ventricular assist device (LVAD) implantation in these patients. We aimed to investigate whether prior MC implantation affects the subsequent LVAD implantation and outcome.Methods and resultsThirty‐seven patients with advanced HF and significant MR who underwent LVAD implantation were retrospectively analysed. Follow‐up data were collected at 1 year after LVAD implantation. Primary endpoint was all‐cause mortality. Secondary endpoint included peri‐operative parameters and clinical development depicted as New York Heart Association (NYHA) class and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level. Seventeen patients initially received a MC device (MC group), resulting in a significant reduction in MR grade. After MC, NYHA class and INTERMACS level further worsened, leading to subsequent LVAD implantation after a median time of 475 days in the MC group. At LVAD implantation, overall characteristics were comparable with those of the patients undergoing LVAD implantation without prior MC placement (no‐MC group). Procedural data revealed a higher incidence of right ventricular (RV) failure needing mechanical RV assistance and a longer need for nitric oxide ventilation in the MC group after LVAD implantation. One‐year survival was slightly better in the no‐MC group compared with the MC group [41% (n = 7/17) vs. 65% (n = 13/20); P = 0.15], albeit event‐free survival was comparable between both groups, MC and no‐MC.ConclusionsLVAD implantation after MC is feasible and safe. However, in patients with advanced HF and severe MR, PMVR may only delay a needed LVAD implantation and thereby lead to poorer peri‐operative RV function and impaired outcome. Arguably, these patients might benefit from the timely management of advanced HF by the means of early LVAD implantation or heart transplantation.

Impact of atrial fibrillation on outcomes following MitraClip: A contemporary population-based analysis.

Despite the rising use of MC, the impact of preexisting AF, a common comorbidity, on short-term postprocedural outcomes is poorly defined. We sought to assess outcomes between patients with and without atrial fibrillation (AF) who underwent percutaneous mitral valve repair with MitraClip (MC). In this retrospective cohort study, the Nationwide Readmissions Database was queried for patients who underwent MC between 2014-2017. Groups were stratified based on the presence of AF. Multivariable logistic regression analyses were performed to identify the association between AF and in-hospital stroke and mortality. Of the 15,570 patients who underwent MC, 7,740 (49.7%) had AF. AF patients were older (82 vs. 79 years, p < .001) and more comorbid. Patients with AF relative to without AF demonstrated increased rates of in-hospital ischemic (1.3% vs .0.7%, p < .001) and hemorrhagic stroke (0.3% vs. 0.1%, p=.007), longer duration of hospitalization (median 3 vs. 2 days, p < .001), and similar in-hospital mortality (2.8% vs. 2.6%, p=.52). After adjusting for comorbidities, age, sex, hospital procedural volume, and CHA2DS2-VASc, the presence of AF was associated with higher in-hospital stroke (OR=2.096, 95%CI[1.503-2.921], p < .001) but not in-hospital mortality (OR=1.012, 95%CI[0.828-1.238], p=.904). AF patients were more likely to be readmitted (16.8% vs.14.1%, p < .001) and die (1.5% vs. 0.9%, p=.005) within 30 days of discharge despite similar incidences of stroke (0.7% vs. 0.6%, p=.53). The increased risk of in-hospital stroke, 30-day mortality, and longer hospitalization suggest the need for increased preprocedural optimization by means of stroke prevention strategies in those with AF undergoing MC.

Impact of atrial fibrillation on outcomes of patients treated by transcatheter mitral valve repair: A systematic review and meta-analysis.

Background:Conflicting data have been reported related to the impact of atrial fibrillation (AF) on outcomes after transcatheter mitral valve repair with MitraClip (MC) implantation. In this study, we assessed the prognosis of MC-treated patients according to the presence of pre-existing AF.Methods:Randomized and observational studies reporting outcomes of pre-existing AF or sinus rhythm in patients undergoing MC treatment were identified with an electronic search. Outcomes of interest were short-and long-term mortality, stroke, bleeding, rehospitalization, myocardial infarction (MI), cardiogenic shock, acute procedure success, the hospital stay, and the number of Clips implanted.Results:Eight studies (8466 individuals) were eligible. Compared to sinus rhythm, long-term mortality, the risk of bleeding, rehospitalization, and longer hospital stay were significantly higher in AF groups, whereas similar correlations were found in the analysis of other outcomes.Conclusion:AF may be related with worse outcomes in patients undergoing MC implantation, including long-term mortality, major bleeding, and rehospitalization. AF should be taken into account when referring a patient for MC treatment.

The impact of advances in percutaneous catheter interventions on redo cardiac surgery.

Toward the end of the twentieth century, redo cardiac surgery accounted for approximately 15-20% of total cardiac surgical volume. Major risk factors for redo cardiac surgery include young age at time of the first operation, progression of native coronary artery disease (CAD), vein graft atherosclerosis, bioprosthetic valve failure and endocarditis, and transplantation for end stage heart failure. Historically, redo coronary artery bypass grafting (CABG) alone carried a mortality risk of around 4%. Factors such as older age, female sex, comorbidities, combined procedures, hemodynamic instability, and emergency procedures contributed to even higher mortality and morbidity. These poor outcomes made it necessary to look for less invasive alternate methods of treatment. Advances in catheter-based interventions have made a major impact on redo cardiac surgeries, making it no longer the first option in a majority of cases. Percutaneous interventions for recurrence following CABG, transcutaneous aortic valve replacement (TAVR) for calcific aortic stenosis, valve in valve (VIV) implantations, device closure of paravalvular leaks (PVL), and thoracic endovascular aortic repair (TEVAR) for residual and recurrent aneurysms and mitral clip to correct mitral regurgitation (MR) in heart failure are rapidly developing or developed, obviating the need for redo cardiac surgery. Our intent is to review these advances and their impact on redo cardiac surgery.

Identification of Subclinical Myocardial Dysfunction and Association with Survival after Transcatheter Mitral Valve Repair

Transcatheter mitral valve repair (TMVr) using edge-to-edge mitral valve clip is effective for patients with mitral regurgitation (MR) and high or prohibitive surgical risk. Global longitudinal strain (GLS) allows evaluation of subclinical myocardial dysfunction, but its incremental clinical utility into risk stratification, beyond traditional clinical parameters, is unknown in patients treated with TMVr. We sought to evaluate the association of baseline GLS with 1-year all-cause mortality in patients treated with TMVr using edge-to-edge mitral valve clip. We analyzed 155 patients who underwent transcatheter edge-to-edge mitral valve clip implantation (mean age, 83±7years; 48% were women; mean left ventricular ejection fraction, 56%±10%, Society of Thoracic Surgeons Predicted Risk of Mortality score for repair, 6.62%±5.22%). Baseline left ventricular GLS was obtained by two-dimensional speckle-tracking echocardiography, averaging 18 segments from three apical views. Receiver operating characteristic analyses were used to assess the GLS cut point associated with all-cause mortality. Multivariable models with Cox regression tested its relationship after adjustment for baseline comorbidities. During a median follow-up of 316days, all-cause deaths occurred in 30 patients at a median of 156days after TMVr. The area under the curve of preoperative GLS associated with the outcome was 0.60, with a cutoff point of -14.5%. Baseline GLS>-14.5% was associated with 1-year mortality (hazard ratio=2.50; 95% CI, 1.20-5.21; P=.02) before and after adjustment for baseline characteristics. After accounting for baseline characteristics, patients with GLS>-14.5% had worse 1-year mortality than those with GLS≤-14.5% (χ2P<.001). In nested Cox proportional hazards models, the addition of baseline GLS to Society of Thoracic Surgeons Predicted Risk of Mortality score, left ventricular ejection fraction, and the etiology of MR significantly increased the model χ2 value (χ2=12.32). Baseline GLS is independently associated with 1-year all-cause mortality in patients who undergo TMVr, and its assessment improves risk stratification in these patients.

Association of baseline kidney disease with outcomes of transcatheter mitral valve repair by MitraClip.

This study sought to determine the impact of baseline chronic kidney disease (CKD) on in-hospital outcomes of transcatheter mitral valve repair with MitraClip (MC). MC is now an established treatment in high surgical risk patients. However, limited data are available on outcomes of MC in patients with baseline renal dysfunction. The authors used data from January 2014 to December 2017 National Readmission Database to identify all patients ≥18 years of age who underwent MC. International classification of diseases (ICD)-9 and ICD-10 codes were used to identify patients with no-CKD, CKD (without chronic dialysis), or end-stage renal disease (ESRD) on dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in-hospital outcomes. Of 13,563 patients undergoing MC, 8,935 (65.8%) had no-CKD, 4,152 (30.6%) had CKD, and 476 (3.5%) had ESRD. ESRD patients compared to CKD and no-CKD had significantly higher mortality (7.2% vs. 2.5% vs. 2.0%; p < .001), higher incidence of bleeding, blood transfusions, and 30 day all cause readmission. CKD patients compared to no-CKD had significantly higher mortality (odds ratio-1.29; CI 1.01-1.65; p=.04), acute kidney injury (odds ratio-3.0; CI 2.69-3.34; p < .001), new in-hospital hemodialysis (odds ratio- 2.70; CI 1.57-4.62; p < .001), blood transfusions, 30 day all cause and congestive heart failure (CHF) readmissions. In-hospital stroke and cardiac tamponade did not differ between the three groups. Patients with baseline kidney disease undergoing MC had higher mortality at high volume centers compared to low volume centers. CHF was the most common cause of readmission postMC in patients with or without preprocedural kidney disease. Patients with baseline kidney disease have worse outcomes after MC with higher readmission rates requiring careful patient selection and follow up in this population.

COMPARISON BETWEEN MITRAL CLIP THERAPY AND SURGICAL REPAIR OF MITRAL REGURGITATION IN PATIENTS WITH LEFT VENTRICULAR DYSFUNCTION

Background: Mitral-valve repair can be accomplished with a procedure that involves the percutaneous implantation of a clip that grasps and approximates the edges of the mitral leaflets at the origin of the regurgitate jet. Objective: Our study was performed to compare surgical repair and mitral clip repair for severe secondary MR after failure of maximum medical treatment. Patients and methods: We none randomly were sixty patients with moderately severe or severe (grade 3+ or 4+) mitral regurgitation, 30 patients underwent percutaneous repair by clip and 30 patients underwent conventional surgery for repair of the mitral valve. The primary composite end point for efficacy was freedom from death, required surgery for mitral valve dysfunction (stenosis or regurgitation), and absence of significant MR (grade 3+ or 4+) at 6 months follow up. Results: At 6 months, the rates of the primary end point for efficacy were 79% in the percutaneous repair group and 60% in the surgery group (P = 0.020). The respective rates of the components of the primary end point were as follows: death, 6.9%versus 25%, required surgery for mitral-valve dysfunction, 6.9% versus 10.7%; and significant MR, 16% versus 33%. Major adverse events occurred in 20% of patients in the percutaneous-repair group and 50% of patients in the surgery group at 30 days (P<0.001). Conclusions: Percutaneous treatment was associated with increased safety, improved left ventricular volumes, clinical improvements in NYHA classes and quality of life.

Mitral Stenosis After MitraClip: How to Avoid and How to Treat.

The goal of the paper is to highlight the importance of procedural planning and patient selection when using the MitraClip device in treating severe mitral regurgitation (MR). Following the recent results of the COAPT trial and FDA approval for functional MR patients, the indications for mitral clip are continuing to expand. Because of this, mitral stenosis from mitral clip can become a problem if the appropriate patients are not selected. Proper valve imaging, utilizing 3D transesophageal echocardiography to identify the pathology, is important to prevent iatrogenic mitral stenosis. In the unfortunate event of severe mitral stenosis as a result of the MitraClip device, surgery is the only treatment.

Cerebrovascular events after transcatheter mitral valve interventions: a systematic review and meta-analysis

ObjectiveCurrent guidelines support the use of transcatheter mitral valve interventions to treat some selected high-risk patients with significant mitral valvulopathy. As with any other interventional cardiac procedure, concerns have been...

THE INCIDENCE OF STROKE WITHIN 30 DAYS AFTER MITRAL CLIP A SYSTEMATIC REVIEW AND META-ANALYSIS

Stroke is one of the potential complications of mitral clip (MC) procedure with a reported incidence of 0.2% to 2.8%. We studied the incidence of stroke at 30 days after a mitral clip (MC) by performing meta-analysis from previously published literature. Ovid, Medline, Embase, Scopus and Cochrane

ACUTE CHANGES IN MITRAL ANNULAR DIMENSIONS ON 3D TRANSESOPHAGEAL ECHOCARDIOGRAPHY AFTER MITRACLIP TREATMENT OF MITRAL REGURGITATION: A PILOT STUDY

Transcatheter mitral valve repair(TMVr) with MitraClip(MC) is beneficial in selected patients with symptomatic severe mitral regurgitation(MR). We evaluate acute changes in mitral annular dimensions analyzed by 3D transesophageal echocardiography(TEE). 19 patients undergoing TMVr with MC had 3D TEE

USE OF MITRACLIP FOR TRICUSPID REGURGITATION IN A PATIENT WITH L-LOOP TRANSPOSITION OF THE GREAT ARTERIES

Transcatheter repair of a regurgitant mitral valve may be achieved with the MitraClip (MC), mimicking a surgical Alfieri stitch. Here we report the use of MC for severe tricuspid regurgitation (systemic atrio-ventricular valve [SAVV]) in a patient with L-loop transposition of the great arteries (L-

Predictors of left ventricular reverse remodeling after percutaneous therapy for mitral regurgitation with the MitraClip system.

To investigate the predictors and clinical impact of left ventricular reverse remodeling (LVRR) after MitraClip (MC) therapy for degenerative (DMR) and functional mitral regurgitation (FMR). MC therapy induces LVRR in patients with mitral regurgitation (MR) at high-risk for surgery. However, specific data on predictors of LVRR therapy are limited. This study included 164 patients treated by MC implantation with complete clinical and echocardiographic evaluation at baseline, 6 months, and 12 months. LVRR was defined as a decrease of ≥10% of the left ventricular end-diastolic diameter after 12 months and was found in 49% of the patients. LVRR was associated with significantly reduced event rate 2 years after MC procedure. In the total cohort, multivariate regression analysis determined severe recurrent/residual MR after 12 months (p = .010, odds ratio [OR] = 0.26), male gender (p = .050, OR = 0.49) and left ventricular ejection fraction (LVEF) <20% (p = .046, OR = 0.24) as predictors of absence of LVRR. In the subgroup analysis according to etiology of MR, multivariate regression analysis revealed severe recurrent/residual MR after 12 months (p = .04, OR = 0.184) to inversely predict LVRR only in the DMR subgroup. In FMR, residual severe tricuspid regurgitation (TR) inversely predicts LVRR (p = .032, OR = 0.361). LVRR occurs in half of the patients after MC and is associated with reduced MACCE rates at follow-up. Combined information on residual/recurrent MR, baseline LVEF and gender predict LVRR after MC procedure. While residual/recurrent MR is the independent predictor for the absence of LVRR in DMR, in FMR only severe residual TR independently predict LVRR.

Characteristics and outcomes of patients with normal left atrial pressure undergoing transcatheter mitral valve repair

ObjectiveA subset of patients at the time of transcatheter mitral valve repair (TMVR) will have normal left atrial pressure (LAP) (<13 mm Hg) despite having severe mitral regurgitation (MR). The...

P1710 Reverse right ventricular remodeling using right ventricular strain and strain rate after mitral clip implantation in functional mitral regurgitation, an echocardiographic study

Abstract Funding Acknowledgements none OnBehalf none Background Chronic mitral regurgitation (MR) leads to right ventricular dysfunction because of volume and pressure overload over a long time. Mitral valve repair with a mitral clip will reduce the (MR) but how much its effect on the right ventricle. Aim The aim of the present study is to assess the impact of Mitral Valve Clipping on right ventricular (RV) remodeling (RV strain and strain rate) at med term after Mitral Clip implantation in high-risk surgical patients with severe functional mitral regurgitation (MR). Methods Study population included 62 patients with severe functional MR. All the patients underwent full echocardiographic evaluation before MV clip, and at 12-month follow-up. RV systolic function was assessed using tissue Doppler and TAPSE. Using Tom-Tec software the RV endocardium is traced in the apical 4 chamber view to get the RV strain and strain rate. RV after load was evaluated using systolic pulmonary artery pressure. Results In our cohort, 62 patients had percutaneous mitral valve clip and completed at least 12 months of follow-up. The average age was 60.56 years, 24.19 were females, 50% were diabetic, 46.77 were hypertensive, 12.90 had ESRD and 11.29 % had anemia. Coronary artery disease (CAD) was present in 59.41 %, prior CABG in 11.67% and prior PCI in 35.48%. All parameters value was compared pre MV clip and 12 ± 4.6 months after MV clip. The RV longitudinal strain was -12.4 ± 2.6% and improved to -14.6 ± 3.1% (P 0.005) (Figure A and B). The RV strain rate was -1.1 ± 0.41 and improved to -1.3 ± 0.57 (P 0.004) (Figure C and D). The tricuspid annulus plane systolic excursion (TAPSE) was 1.76 ±0.57 mm, and improved to 1.82 ±0.63 mm (P 0.4). The systolic velocity at the tricuspid annulus was 9.50 ±2.33cm/sec and improved to 9.64 ±2.72 cm/sec (P 0.269). The systolic pulmonary artery pressure (SPAP) was 50.49 ±13.92 and improved to 42.33 (P 0.036). Conclusion Mitral Clip implantation induces a significant reverse remodeling of RV. It produces significant improvement in the hemodynamics of the right side indicated by the significant reduction in SPAP and a significant increase in longitudinal RV strain and strain rate. Those changes could be a direct reflection of the concomitant reduction in LV filling pressure produced by the significant reverse remodeling of the LV caused by Mitral Clipping. Abstract P1710 Figure.

P869 Effect of transcatheter MitraClip implantation on exercise performance evaluated by CPET

Abstract Background &amp; Purpose Transcatheter MitraClip (MC) implantation has become the most frequently used percutaneous technique to treat severe mitral regurgitation (MR) in patients with high surgical risk. The assessment whether transcatheter MC implantation is the most suitable procedure on each individual patient is done primarily by 2D transthoracic echocardiography (TTE) as well as transesophageal echocardiography (TEE). In this case of a 79-year-old male multimorbid patient with cardiac amyloidosis and severe MR, different imaging modalities were used to assess the heart before and after MC implantation. The dynamic response of the heart after transcatheter MC approach was evaluated by comparing the patient’s exercise capacity before and after treatment with cardiopulmonary exercise testing (CPET). Methods Total body bone scintigraphy, 714 MBq 99m-Tc DPD, was performed to confirm the diagnosis of cardiac transthyretin (ATTR) amyloidosis. The extent of mitral regurgitation was assessed using TTE and TEE before and after MC implantation. Coronary angiography and right heart catheterization were performed prior to MC implantation. CPET by a cycle ergometer was used to measure the dynamic response of the heart before and after the procedure. A ramp protocol, adapted to reach maximal capacity after 8-10 min was chosen for the test. The parameter of main interest was maximal oxygen uptake (VO2 max, ml/min), the major factor known to limit exercise capacity. Results Bone scan showed tracer accumulation in myocardial tissue, genetic testing was negative which confirmed wild type cardiac transthyretin (ATTR) amyloidosis. Significant coronary artery disease was excluded by coronary angiography. Right heart catheterization disclosed post capillary pulmonary hypertension: mean pulmonary artery pressure of 42 mmHg and mean pulmonary capillary wedge pressure of 25 mmHg and end-diastolic pressure of left ventricle of 118 mmHg. A high grade left ventricular concentric hypertrophy (IVS = 26mm) with slightly reduced left systolic function, a severe MR (EROA = 35 mm2) and enlargement of left and right atria (LA = 68mm, RA = 68mm) were demonstrated by TTE. In TEE left atrium including left atrial appendage were free from thrombi; high grade left ventricular hypertrophy, restriction of posterior leaflet and severe MR with eccentric jet with dilated annulus were demonstrated. CPET before MC implantation: VO2 max 1299 ml/min (83% of predicted peak oxygen uptake value). MC implantation was performed with no post-procedural complications. Follow-up CPET showed higher VO2 max 1373 ml/min compared to the data before MC implantation (88% predicted peak oxygen uptake value). Conclusions TTE and TEE are the most common and accurate imaging modalities to evaluate MR regarding MitraClip evaluation. After the MC procedure the dynamic response of the heart can be observed by CPET with VO2 as a surrogate marker for heart function. Abstract P869 Figure. a.b. TEE prior to MC, c.d. TEE after MC

Comparison of effectiveness and survival after the MitraClip or Carillon procedure for severe functional mitral regurgitation: a single-center retrospective analysis.

IntroductionCurrent studies suggest improved survival in patients with severe functional mitral regurgitation (FMR) treated successfully with the MitraClip (MC) compared to medical treatment alone, in addition to a significant reduction of FMR severity. Recently, the Carillon system (CS) has also been shown to significantly reduce FMR. However, whether this beneficial effect of CS also translates into a survival benefit comparable to the MC system has not been investigated so far. The aim of the study was to compare the course of FMR grade and mortality after MC or CS in a retrospective, non-randomized, single-center analysis.Material and methodsA hundred and fifty-four patients with symptomatic FMR 2+ were included in this study (MC: n = 117, CS: n = 37). Baseline characteristics did not differ significantly between groups.Results and conclusionsInitially, the degree of FMR was reduced in the MC group from 2.9 ±0.3 to 1.7 ±0.7 and from 2.7 ±0.5 to 2.1 ±0.7 in the CS group, p within and between groups < 0.01. Within 6 months, FMR remained reduced in the MC group (1.83 ±0.6) and CS group (2.1 ±0.7). One-year survival was 34.8% in the MC group and 54.8% in the CS group (p = 0.663). Median long-term survival was 1.66 years in the MC group and 3.92 years in the CS group, log rank p = 0.001.