The acute hemodynamic effects of mitraclip therapy

Robert J. Siegel, Simon Biner, Asim M. Rafique, Michael Rinaldi, Scott Lim, Peter Fail, James Hermiller, Richard Smalling, Patrick L. Whitlow, Howard C. Herrmann, Elyse Foster, Ted Feldman, Donald Glower, Saibal Kar

Research output: Contribution to journalArticlepeer-review

Abstract

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)

Original languageEnglish
Pages (from-to)1658-1665
Number of pages8
JournalJournal of the American College of Cardiology
Volume57
Issue number16
DOIs
StatePublished - 19 Apr 2011
Externally publishedYes

Keywords

  • MitraClip
  • cardiac output
  • hemodynamics
  • mitral regurgitation

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