TY - JOUR
T1 - The acute hemodynamic effects of mitraclip therapy
AU - Siegel, Robert J.
AU - Biner, Simon
AU - Rafique, Asim M.
AU - Rinaldi, Michael
AU - Lim, Scott
AU - Fail, Peter
AU - Hermiller, James
AU - Smalling, Richard
AU - Whitlow, Patrick L.
AU - Herrmann, Howard C.
AU - Foster, Elyse
AU - Feldman, Ted
AU - Glower, Donald
AU - Kar, Saibal
N1 - Funding Information:
Dr. Siegel is a speaker for Philips Ultrasound and a consultant for Abbott. Dr. Rinaldi is on the advisory boards of Abbott, Boston Scientific, and Cordis. Dr. Lim is a consultant to and receives research funding from Abbott Vascular . Dr. Fail is on the medical advisory board for and has stock options in CardioSolutions. Dr. Hermiller is a consultant for Abbott Vascular. Dr. Smalling receives grant support from Evalve . Dr. Whitlow receives research support from Evalve . Dr. Hermann receives research funding from Evalve and Abbott and has equity in and is a consultant to Endovalve. Dr. Foster receives grant support from Evalve , Boston Scientific , EBR Systems , and GDS Systems . Dr. Feldman receives research support and is a consultant to Abbott and Edwards. Dr. Kar receives research grants and honoraria from and is a consultant to Abbott Vascular . All other authors have reported that they have no relationships to disclose. Drs. Siegel and Biner contributed equally to this work.
PY - 2011/4/19
Y1 - 2011/4/19
N2 - Objectives: The objective of this study was to evaluate the acute hemodynamic consequences of mitral valve (MV) repair with the MitraClip device (Abbott Vascular, Menlo Park, California). Background: Whether surgical correction of mitral regurgitation (MR) results in a low cardiac output (CO) state because of an acute increase in afterload remains controversial. The acute hemodynamic consequences of MR reduction with the MitraClip device have not been studied. Methods: We evaluated 107 patients with cardiac catheterization before and immediately following percutaneous MV repair with the MitraClip device. In addition, pre- and post-procedural hemodynamic parameters were studied by transthoracic echocardiography. Results: MitraClip treatment was attempted in 107 patients, and in 96 (90%) patients, a MitraClip was deployed. Successful MitraClip treatment resulted in: 1) an increase in CO from 5.0 ± 2.0 l/min to 5.7 ± 1.9 l/min (p = 0.003); 2) an increase in forward stroke volume (FSV) from 57 ± 17 ml to 65 ± 18 ml (p < 0.001); and 3) a decrease in systemic vascular resistance from 1,226 ± 481 dyn·s/cm5 to 1,004 ± 442 dyn·s/cm 5 (p < 0.001). In addition, there was left ventricular (LV) unloading manifested by a decrease in LV end-diastolic pressure from 11.4 ± 9.0 mm Hg to 8.8 ± 5.8 mm Hg (p = 0.016) and a decrease in LV end-diastolic volume from 172 ± 37 ml to 158 ± 38 ml (p < 0.001). None of the patients developed acute post-procedural low CO state. Conclusions: Successful MV repair with the MitraClip system results in an immediate and significant improvement in FSV, CO, and LV loading conditions. There was no evidence of a low CO state following MitraClip treatment for MR. These favorable hemodynamic effects with the MitraClip appear to reduce the risk of developing a low CO state, a complication occasionally observed after surgical MV repair for severe MR. (A Study of the Evalve Cardiovascular Valve Repair System Endovascular Valve Edge-to-Edge Repair Study [EVEREST I]; NCT00209339 and EVEREST II; NCT00209274)
AB - Objectives: The objective of this study was to evaluate the acute hemodynamic consequences of mitral valve (MV) repair with the MitraClip device (Abbott Vascular, Menlo Park, California). Background: Whether surgical correction of mitral regurgitation (MR) results in a low cardiac output (CO) state because of an acute increase in afterload remains controversial. The acute hemodynamic consequences of MR reduction with the MitraClip device have not been studied. Methods: We evaluated 107 patients with cardiac catheterization before and immediately following percutaneous MV repair with the MitraClip device. In addition, pre- and post-procedural hemodynamic parameters were studied by transthoracic echocardiography. Results: MitraClip treatment was attempted in 107 patients, and in 96 (90%) patients, a MitraClip was deployed. Successful MitraClip treatment resulted in: 1) an increase in CO from 5.0 ± 2.0 l/min to 5.7 ± 1.9 l/min (p = 0.003); 2) an increase in forward stroke volume (FSV) from 57 ± 17 ml to 65 ± 18 ml (p < 0.001); and 3) a decrease in systemic vascular resistance from 1,226 ± 481 dyn·s/cm5 to 1,004 ± 442 dyn·s/cm 5 (p < 0.001). In addition, there was left ventricular (LV) unloading manifested by a decrease in LV end-diastolic pressure from 11.4 ± 9.0 mm Hg to 8.8 ± 5.8 mm Hg (p = 0.016) and a decrease in LV end-diastolic volume from 172 ± 37 ml to 158 ± 38 ml (p < 0.001). None of the patients developed acute post-procedural low CO state. Conclusions: Successful MV repair with the MitraClip system results in an immediate and significant improvement in FSV, CO, and LV loading conditions. There was no evidence of a low CO state following MitraClip treatment for MR. These favorable hemodynamic effects with the MitraClip appear to reduce the risk of developing a low CO state, a complication occasionally observed after surgical MV repair for severe MR. (A Study of the Evalve Cardiovascular Valve Repair System Endovascular Valve Edge-to-Edge Repair Study [EVEREST I]; NCT00209339 and EVEREST II; NCT00209274)
KW - MitraClip
KW - cardiac output
KW - hemodynamics
KW - mitral regurgitation
UR - http://www.scopus.com/inward/record.url?scp=79953842404&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2010.11.043
DO - 10.1016/j.jacc.2010.11.043
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C2 - 21492763
AN - SCOPUS:79953842404
SN - 0735-1097
VL - 57
SP - 1658
EP - 1665
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 16
ER -
