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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Pre-procedural predictors for multiple clips in percutaneous edge-to-edge mitral valve repair

Mohammad El Garhy1,2,3, Bernward Lauer4, Björn Göbel5

  • 1Department of cardiology, Central Clinic Bad Berka, Robert-Koch Allee 9, 99437, Bad Berka, Germany. mohammed.elgarhy@zentralklinik.de.

The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology
|September 14, 2021
PubMed
Abstract

Insights

Predicting the number of mitral valve (MV) clips needed for mitral regurgitation (MR) is crucial. Wider vena contracta predicts multiple clips, while severe annular calcification predicts a single clip.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Percutaneous mitral valve (MV) clipping is a key treatment for mitral regurgitation (MR).
  • Valve anatomy and pathology significantly influence procedural outcomes.
  • Predicting the need for multiple clips pre-procedurally can optimize treatment planning.

Purpose of the Study:

  • To identify pre-procedural predictors for the number of clips used during MV clipping procedures.
  • To evaluate echocardiographic parameters associated with single versus multiple clip usage.

Main Methods:

  • Retrospective analysis of 127 patients with severe MR undergoing MV clipping.
  • Comparison of pre-procedure echocardiographs between patients receiving single (Group I) and multiple clips (Group II).
  • Multivariate analysis to determine independent predictors for multiple clip usage.

Main Results:

  • Wider vena contracta (6.6 ± 1 mm vs. 6 ± 0.9 mm) was associated with multiple clip usage (p=0.001).
  • Severe mitral annular calcification was more frequent in single-clip patients (36.2% vs. 10.1%, p=0.0001).
  • Multivariate analysis confirmed vena contracta width positively correlated with multiple clips (B=0.125, p=0.013) and severe annular calcification inversely (B=-0.35, p=0.002).

Conclusions:

  • Vena contracta width is a positive predictor for requiring multiple MV clips.
  • Severe mitral annular calcification is an inverse predictor, suggesting suitability for single-clip procedures.
  • These factors are important considerations for pre-procedural planning in MV clipping.
Keywords:
MitraClipMitralRegurgitation

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