P479Persistent iatrogenic atrial septal defect after percutaneous mitral valve repair using the MitraClip system: one step forward or two steps back

Abstract

Background: Percutaneous Mitral valve repair (PMVR) using the MitraClip System has become a well-established therapeutic option for inoperable patients with symptomatic mitral regurgitation. The procedure is performed with standard technique employing a 22-French transseptal guiding catheter. Purpose: This single center prospective study sought to evaluate the persistence rate as well as impact on echocardiographic and clinical outcome of iatrogenic atrial septal defect (iASD) after PMVR by the MitraClip system. Methods: 39 patients (20 male, 75±9 years) with symptomatic mitral regurgitation and at high surgical risk (EuroSCORE 24±12%) undergoing PMVR were included. Clinical and echocardiographic follow-up was performed after 6 months in all patients. Results: Success rate of PMVR was 100%. Clinical and echocardiographic follow-up at 6 months was obtained in all patients. Transesophageal echocardiography showed a persistent iASD in 21 patients (54%). Baseline clinical parameters were comparable between subject with iASD (iASD group) and those without persisting iASD (non-iASD). In addition, groups were comparable regarding left ventricular dimensions, left atrial area, right atrial area, right ventricular systolic pressure, TAPSE and hemodynamic parameters. Left ventricular ejection fraction was lower in iASD group compared to non-iASD group (33±13% vs. 43±15%; p=0.032). Clinically, there were no difference between the iASD group and non-iASD group with respect to NYHA class >II at 6 months follow-up (36% vs. 35%; p=1.000) (table 2). Univariate predictor of persistent iASD was only reduced left ventricular ejection fraction at baseline (OR=0.98; 95% CI =0.96-0.99; p=0.032) Conclusion: The incidence of persistent iASD after PMVR was high at 6 months follow-up. However, patients with persistent iASD were clinically not compromised compared to non-iASD patients. (Table Presented).