Author + information
- Received July 26, 2019
- Revision received August 30, 2019
- Accepted September 4, 2019
- Published online December 16, 2019.
- Noriaki Tabata, MDa,b,
- Marcel Weber, MDa,
- Atsushi Sugiura, MDa,
- Can Öztürk, MDa,
- Masanobu Ishii, MD, MPHb,
- Kenichi Tsujita, MDb,
- Georg Nickenig, MDa and
- Jan-Malte Sinning, MDa,∗ ()
- aHeart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
- bDepartment of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- ↵∗Address for correspondence:
Dr. Jan-Malte Sinning, Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn Germany.
Objectives This study sought to investigate the clinical impact of leaflet-to-annulus mismatch on residual mitral regurgitation (MR) after percutaneous edge-to-edge mitral repair.
Background Annular dilation is a common feature of secondary MR, which requires concomitant annuloplasty in surgical mitral valve repair.
Methods Consecutive MR patients undergoing MitraClip (Abbott Vascular, Santa Clara, California) implantation in the Heart Center Bonn were enrolled. Residual MR was defined as a post-procedural MR ≥2+ and patients were stratified into 2 groups according to the residual MR. The study calculated the leaflet-to-annulus index (LAI) using pre-procedural 2- and 3-dimensional transesophageal echocardiography. All-cause death within a 1-year follow-up was examined.
Results Of 420 consecutive patients, 117 (27.9%) patients had residual MR (≥2+). Patients with residual MR had a significantly lower pre-procedural LAI than did those with MR <2+ (median 1.14 [interquartile range (IQR): 1.07 to 1.20] vs. 1.18 [IQR: 1.12 to 1.29]; p < 0.001). A multivariable analysis revealed that the LAI value was significantly associated with residual MR (odds ratio: 0.95; p < 0.001). After 1-year follow-up, patients with residual MR had a significantly worse prognosis than did patients with MR <2+ (estimated mortality rate 17.4% vs. 7.3%; log-rank p = 0.002), and the presence of residual MR was independently correlated with 1-year mortality (hazard ratio: 2.74; p = 0.004).
Conclusions The LAI value is associated with residual MR after MitraClip implantation, which is independently correlated with 1-year mortality. This index might be a useful tool to identify patients with the need for concomitant annuloplasty before edge-to-edge repair.
Dr. Tabata was supported financially in part by a Fellowship from the Astellas Foundation for Research on Metabolic Disorders and the Uehara Memorial Foundation. Drs. Nickenig and Sinning have received speaker honoraria and research grants from Abbott, Abiomed, Medtronic, Boston Scientific, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 26, 2019.
- Revision received August 30, 2019.
- Accepted September 4, 2019.
- 2019 American College of Cardiology Foundation
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