alexa Persistence of iatrogenic atrial septal defect after interventional mitral valve repair with the MitraClip system: a note of caution.
Surgery

Surgery

Journal of Vascular Medicine & Surgery

Author(s): Schueler R, ztrk C, Wedekind JA, Werner N, Stckigt F,

Abstract Share this page

Abstract OBJECTIVES: The purpose of this study was to investigate the persistence rates of iatrogenic atrial septal defect (iASD) after interventional edge-to-edge repair with serial transesophageal echocardiography examinations and close clinical follow-up (FU). BACKGROUND: Transcatheter mitral valve repair (TMVR) with the MitraClip system (Abbott Vascular, Abbott Park, Illinois) is a therapeutic alternative to surgery in selected high-risk patients. Clip placement requires interatrial transseptal puncture and meticulous manipulation of the steerable sheath. The persistence of iASD after MitraClip procedures and its clinical relevance is unknown. METHODS: A total of 66 patients (76.7\% male, mean age 77.1 ± 7.9 years) with symptomatic mitral regurgitation (MR) at prohibitive surgical risk (EuroSCORE II 10.1 ± 6.1\%) underwent MitraClip procedures and completed 6 months of FU. RESULTS: Transesophageal echocardiography after FU showed persistent iASD in 50\% of cases. Patients with iASD did not significantly differ from patients without ASD concerning baseline characteristics, New York Heart Association functional class, severity of MR, and acute procedural success rates (p > 0.05). When comparing procedural details and hemodynamic measures between groups, MitraClip procedures took longer in patients without iASD (82.4 ± 39.7 min vs. 68.9 ± 45.5 min; p = 0.05), and echocardiography after FU showed less decrease of systolic pulmonary artery pressures in the iASD group (-1.6 ± 14.1 mm Hg vs. 9.3 ± 17.4 mm Hg; p = 0.02). Clinically, patients with iASD presented more often with New York Heart Association functional classes >II after FU (57\% vs. 30\%; p = 0.04), showed higher levels of N-terminal pro-brain natriuretic peptide (6,667.3 ± 7,363.9 ng/dl vs. 4,835.9 ± 6,681.7 ng/dl; p = 0.05), and had less improvement in 6-min walking distances (20.8 ± 107.4 m vs. 114.6 ± 116.4 m; p = 0.001). Patients with iASD showed higher death rates during 6 months (16.6\% vs. 3.3\%; p = 0.05). Cox regression analysis found that only persistence of iASD (p = 0.04) was associated with 6-month survival. CONCLUSIONS: The persistence rate of 50\% iASD after MitraClip procedures is considerably high. Persistent interatrial shunting was associated with worse clinical outcomes and increased mortality. Further studies are warranted to investigate if persistent interatrial shunting is the mediator or marker of advanced disease in these patients. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. This article was published in JACC Cardiovasc Interv and referenced in Journal of Vascular Medicine & Surgery

Relevant Expert PPTs

Relevant Speaker PPTs

Recommended Conferences

  • International Conference on Vascular Biology & Medicine
    July 24-25, 2017 Chicago, USA
  • 19th Annual Cardiology Conference (10 Plenary Forums - 1 Event)
    August 31-September 01, 2017 Philadelphia, USA

Relevant Topics

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords