Use of Pleth Variability Index as a Non-invasive, Dynamic Indicator of Left Atrial Pressure Change During MitraClip:
Ashwin Vaidyanathan1, Jayakar Guruswamy1, Abhishek Saluja1
1Department of Anesthesiology, Pain Management, and Perioperative Medicine, Henry Ford Hospital, Detroit, MI, USA.
Background:
Transcatheter edge-to-edge repair (TEER) with MitraClip is a safe and effective alternative to surgical mitral valve repair/replacement in patients with high operative risk. Pleth Variability Index (PVI) is a non-invasive, dynamic index based on analysis of the respiratory variations in the plethysmographic waveform recorded transcutaneously by the pulse oximeter.
Objectives:
The objective of the study was to evaluate if the hemodynamic effect of improved left-sided output after successful transcatheter mitral valve repair would lead to a significant change in PVI, and if it would correlate with the decrease in left atrial pressure (LAP).
Design:
Prospective, observational cohort study (ClinicalTrials.gov NCT03993938).
Setting:
Single academic hospital in Detroit, Michigan (USA), from October 2019 to February 2021.
Participants:
The authors included adult patients with severe mitral regurgitation who underwent successful MitraClip placement.
Measurements And Main Results:
Of 30 patients, all components of the LAP (a wave, v wave, and mean) decreased significantly after successful MitraClip placement (P < .01). The median (IQR) PVI increased from 21 (11-35) to 23 (13-38) after clip placement; however, this change was not statistically significant (P = .275). No significant correlation between change in PVI and change in LAP was observed (P = .235).
Conclusions:
In patients with severe mitral regurgitation, successful MitraClip resulted in a significant reduction in LAP without a significant change in PVI. A larger sample size may provide more insight on the utility of using PVI as an indicator of LAP change in patients with mitral regurgitation.
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