Real Time Hemodynamic Monitoring During M-TEER Using Electrical Cardiometry

Mitral regurgitation is a common valvular dysfunction causing patient morbidity and mortality. Mitral transcatheter edge-to-edge repair (M-TEER) allows grasping of valvular leaflets and approximation via a small implant, thus reducing mitral regurgitation (MR). The implant allows staged leaflet capture and leaflet optimization before it is finally released. Real time hemodynamic monitoring could facilitate procedural success and improve patient outcomes.

Fourteen patients scheduled for elective M-TEER were included in this study. Right heart catheterization (RHC) and determination of cardiac stroke volume (SV) using the established Fick method, pulmonary capillary wedge pressure (PCWP), PCWP v-wave, left atrial (LA) pressure and LA v-wave were carried out pre and postprocedurally. Concomitantly, real time SV was measured via electrical cardiometry and acquired data were compared.

A significant increase in cardiac stroke volume measured via RHC was observed after successful M-TEER. Even though pre- and postprocedural RHC and electrical cardiometry measurements correlated significantly, electrical cardiometry was not able to reproduce the absolute increase in SV seen on RHC measurements. Furthermore, a decrease in PCWP mean pressure, PCWP v-wave, LA mean pressure and LA v-wave, were observed.

Cardiac SV increases after successful M-TEER as measured via RHC but electrical cardiometry was not able to reproduce these changes in a real time, beat-to-beat measurement.