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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
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Correlation of Intraprocedural and Follow Up Parameters for Mitral Regurgitation Grading after Percutaneous

Eduardo Pozo Osinalde1,2, Alejandra Salinas Gallegos1,3,4, Ximena Gordillo1,5

  • 1Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain.

Journal of Clinical Medicine
|May 14, 2022
PubMed

Insights

Maximum and additive vena contracta (VC) measurements during transcatheter edge-to-edge mitral repair (TEER) effectively predict persistent significant mitral regurgitation (MR) on follow-up echocardiograms.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Echocardiography

Background:

  • Lack of consensus on optimal intraprocedural parameters for assessing residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral repair (TEER).
  • Need for reliable echocardiographic predictors to guide post-TEER management and evaluate long-term outcomes.

Purpose of the Study:

  • To evaluate the predictive value of intraprocedural transesophageal echocardiogram (TEE) parameters for residual MR grading on follow-up transthoracic echocardiogram (TTE).
  • To identify the most reliable TEE parameter for predicting significant MR persistence after TEER.

Main Methods:

  • Retrospective analysis of 88 patients undergoing TEER with MitraClip between 2010 and 2020.
  • Reassessment of intraprocedural TEE-derived MR parameters and comparison with follow-up TTE MR grading.
  • Receiver Operating Characteristic (ROC) curve analysis to determine the discriminatory power of TEE parameters.

Main Results:

  • Significant MR persisted in 14.3% of patients at 6 months post-TEER.
  • Only additive and maximum vena contracta (VC) were associated with significant MR persistence.
  • Maximum VC demonstrated excellent discriminatory power (AUC 0.96) for MR ≥ Grade III at 6 months, with a cutoff of 0.45 cm showing 88% sensitivity and 89% specificity.

Conclusions:

  • Intraprocedural maximum and additive VC measurements are reliable predictors of significant residual MR after TEER.
  • A maximum VC cutoff of 0.45 cm can effectively identify patients with persistent moderate-to-severe MR at 6-month follow-up.
Keywords:
echocardiographyfollow upmitral regurgitationmitral regurgitation gradingpercutaneous edge-to-edge mitral repair

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