Continuous invasive hemodynamic monitoring using steerable guide catheter to optimize mitraclip transcatheter mitral valve repair: A multicenter, proof‐of‐concept study. (30th August 2018)

• Record Type: Journal Article
• Authors: Tang, Gilbert H. L.; Ong, Lawrence Y.; Kaple, Ryan; Ramlawi, Basel; Dutta, Tanya; Zaid, Syed; Ahmad, Hasan; Kalimi, Robert; Undemir, Cenap; Khan, Asaad; Yudi, Matias B.; Nadir, M. Adnan; Majeed, Farhan; Ali, Omar; Skiles, Jeffrey; Bhim, Chandra; Cohen, Martin; Lansman, Steven L.; Sharma, Samin K.; Kini, Annapoorna
• Is Part Of: Journal of interventional cardiology. Volume 31:Number 6(2018:Dec.)
• Page Start: 907
• Page End: 915
• Publication Date: 2018-08-30
• Subjects: hemodynamic monitoring -- MitraClip -- mitral regurgitation; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.1206
• DOI: 10.1111/joic.12557
• Languages: English
• ISSNs: 0896-4327

Abstract

Abstract : Objectives: We report our multicenter experience on continuous hemodynamic monitoring using exclusively the steerable guide catheter (SGC) during MitraClip repair. Background: Left atrial pressure (LAP) and V‐wave are useful to evaluate MitraClip repair but no simple method of continuous monitoring exists. Methods: From 11/2016 to 8/2017, 74 patients from four centers with symptomatic moderate‐severe to severe mitral regurgitation (MR), underwent MitraClip NT repair with continuous hemodynamic monitoring via the SGC. Real‐time LAP/V‐wave changes were compared with transesophageal echocardiography (TEE). When mitral stenosis was suspected, transmitral gradients were verified by invasive hemodynamics. Clinical and echocardiographic outcomes were determined. Results: Mean age was 78 ± 10 years and STS score 9.1 ± 11.0%. Pathology included leaflet prolapse/flail (45%), restriction (35%), and mixed (20%). Number of clips averaged 1.7 ± 0.7 per case. There was a significant reduction in LAP (21 ± 10 to 15 ± 7 mmHg, P < 0.0001) and V‐wave(37 ± 19 to 24 ± 10 mmHg, P < 0.0001) post MitraClip, but the decrease was less in patients with atrial fibrillation ( P < 0.05). Transmitral gradient significantly increased from 2.0 ± 1.2 to 4.0 ± 1.7 mmHg ( P < 0.0001). Paradoxical increases in LAP and V‐wave despite MR reduction were observed in three cases requiring MitraClip repositioning or retrieval to avoid stenosis. Follow‐up averaged 5.0 ± 2.9 months and was 100% complete. KCCQ improvement was significant and MR reduction to< 1+ was 67% and< 2+ was 93% at 30 days. Conclusions: Continuous hemodynamic monitoring using the SGC complements TEE to assess and optimize MitraClip repair in real‐time. Further validation is necessary but this feature may be part of future MitraClip and other transcatheter mitral repair systems.