Optimizing MitraClip Outcomes: The Case for Routine Iatrogenic ASD Closure.

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Iatrogenic atrial septal defects (iASD) can arise from MitraClip procedures, potentially leading to right ventricular (RV) volume overload and dysfunction.
• Timely intervention to close iASD may mitigate these adverse effects on RV function.

Purpose of the Study:

• To assess the impact of immediate iASD closure post-MitraClip on RV function, pulmonary resistance, and RV-PA coupling.
• To compare outcomes in patients with concomitant iASD closure versus those with untreated iASD.

Main Methods:

• A study group (ASDc) of 10 patients underwent simultaneous iASD closure with an Amplatzer occluder post-MitraClip.
• A control group (CT) of 9 patients with iASD left untreated was compared.
• Right ventricular function was evaluated using transthoracic echocardiography (TTE) before and after procedures.

Main Results:

• While fractional area change (FAC) showed no significant change in either group, tricuspid annular plane systolic excursion (TAPSE) decreased in both groups.
• A significant reduction in right ventricular systolic pressure (RVSP) was observed overall and was greater in the ASDc group.
• Right ventricle-pulmonary artery coupling (RV-PAc) significantly improved post-iASD closure, indicating enhanced RV performance.

Conclusions:

• iASD closure following MitraClip procedures leads to a notable decrease in RVSP and an improvement in RV-PAc.
• RV-PAc, being independent of preload, suggests improved hemodynamic conditions for RV performance after iASD closure.