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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Iatrogenic atrial septal defect persistence after percutaneous mitral valve repair: a meta-analysis

Oliver Maier1, Katharina Hellhammer2, Patrick Horn1

  • 1Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.

Acta Cardiologica
|June 4, 2021
PubMed
Abstract

Insights

Persistent iatrogenic atrial septal defects (iASD) occur in 28% of patients after percutaneous mitral valve repair (PMVR) at 12 months. This persistence increases the risk of right heart overload and rehospitalization.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Percutaneous mitral valve repair (PMVR) involves transseptal puncture, creating an iatrogenic atrial septal defect (iASD).
  • The persistence and functional consequences of iASD after PMVR are not fully understood.
  • This meta-analysis focuses on summarizing data regarding iASD persistence post-PMVR.

Purpose of the Study:

  • To determine the prevalence of persistent iASD after PMVR.
  • To identify risk factors associated with iASD persistence.
  • To evaluate the functional consequences of persistent iASD.

Main Methods:

  • A systematic literature search was conducted in PubMed/MEDLINE and EMBASE.
  • Six observational studies with a total of 361 patients were included.
  • Data on iASD persistence, size, predictors, and clinical outcomes were analyzed.

Main Results:

  • The prevalence of persistent iASD was 28% at 12 months post-PMVR.
  • iASD size increased over time, from 5.3 mm at 1 month to 6.5 mm at 12 months.
  • Predictors of persistence included pre-existing atrial fibrillation, significant residual mitral regurgitation, and prolonged fluoroscopic time.
  • Persistent iASD was linked to increased right atrial area and right ventricular diameter, indicating right heart overload.
  • Patients with persistent iASD experienced more frequent rehospitalizations.

Conclusions:

  • Iatrogenic atrial septal defect (iASD) persists in 28% of patients 12 months after percutaneous mitral valve repair (PMVR).
  • Persistent iASD is associated with a higher risk of right heart volume overload and increased rehospitalization rates.
  • Given the rise in transseptal procedures, further research on the hemodynamic impact of persistent iASD is crucial.
Keywords:
MitraClip®Mitral valveatrial shuntmitral regurgitationright heart overloadtranscatheter guided therapy

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