P481Acute anatomic changes and clinical outcomes after transcatheter mitral valve repair

Abstract

Introduction: Transcatheter mitral valve repair (TMVR) is an alternative option for patients with severe and symptomatic functional or degenerative mitral regurgitation (MR) at high surgical risk. Acute effect of MitraClip procedure on mitral valve (MV) annular geometry remains unclear. Purpose: We sought to assess immediate effect of TMVR on MV annular geometry and to describe clinical outcomes after TMVR in a tertiary center. Methods: Prospective inclusion of TVMR patients between October 2015 and January 2017. 3D reconstruction of MV annular geometry with transesophageal echocardiography was performed immediately before and after clip implantation using QLAB software. Close follow-up after procedure. Results: A total of 14 patients were included. The mean age was 74.7+9.2 years, 21.4% were women. 78.6% had hypertension, 35.7% diabetes, 64.3% at least stage III chronic kidney disease, 7.15% previous stroke. 78.6% were diagnosed of dilated cardiomyopathy (42.9% of ischemic etiology, 35.7% idiopathic) and 50% of atrial fibrillation. 78.57% had moderate or severe pulmonary hypertension. Mean values of surgical risk scores were: Euroscore I 18.2%, Euroscore II 7.73% and STS 5.15%. MR was functional in 78.6% of patients. Significant reduction in MV diameters, MV 2D and 3D annular circumference and surface, and acute increase in MV ellipticity were observed (table 1). Previous MR grade was III in 14.3% and IV in 85.7%, while after procedure was grade I-II in 93%. During follow-up (median 283 days, interquartile interval 182-378 days), only one death (7.13%) was observed. Conclusions: Significant acute changes in MV geometry and anatomy are observed using three and two-dimensional transesophageal echocardiography after MitraClip® implantation. The procedure is performed in a high-risk population. MR grade is notably reduced and one year survival is high even in patients with important comorbidity.