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The acute hemodynamic effects of MitraClip therapy.

Publication ,  Journal Article
Siegel, RJ; Biner, S; Rafique, AM; Rinaldi, M; Lim, S; Fail, P; Hermiller, J; Smalling, R; Whitlow, PL; Herrmann, HC; Foster, E; Feldman, T ...
Published in: J Am Coll Cardiol
April 19, 2011

OBJECTIVES: The objective of this study was to evaluate the acute hemodynamic consequences of mitral valve (MV) repair with the MitraClip device (Abbott Vascular, Menlo Park, California). BACKGROUND: Whether surgical correction of mitral regurgitation (MR) results in a low cardiac output (CO) state because of an acute increase in afterload remains controversial. The acute hemodynamic consequences of MR reduction with the MitraClip device have not been studied. METHODS: We evaluated 107 patients with cardiac catheterization before and immediately following percutaneous MV repair with the MitraClip device. In addition, pre- and post-procedural hemodynamic parameters were studied by transthoracic echocardiography. RESULTS: MitraClip treatment was attempted in 107 patients, and in 96 (90%) patients, a MitraClip was deployed. Successful MitraClip treatment resulted in: 1) an increase in CO from 5.0 ± 2.0 l/min to 5.7 ± 1.9 l/min (p = 0.003); 2) an increase in forward stroke volume (FSV) from 57 ± 17 ml to 65 ± 18 ml (p < 0.001); and 3) a decrease in systemic vascular resistance from 1,226 ± 481 dyn·s/cm(5) to 1,004 ± 442 dyn·s/cm(5) (p < 0.001). In addition, there was left ventricular (LV) unloading manifested by a decrease in LV end-diastolic pressure from 11.4 ± 9.0 mm Hg to 8.8 ± 5.8 mm Hg (p = 0.016) and a decrease in LV end-diastolic volume from 172 ± 37 ml to 158 ± 38 ml (p < 0.001). None of the patients developed acute post-procedural low CO state. CONCLUSIONS: Successful MV repair with the MitraClip system results in an immediate and significant improvement in FSV, CO, and LV loading conditions. There was no evidence of a low CO state following MitraClip treatment for MR. These favorable hemodynamic effects with the MitraClip appear to reduce the risk of developing a low CO state, a complication occasionally observed after surgical MV repair for severe MR.

Duke Scholars

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

April 19, 2011

Volume

57

Issue

16

Start / End Page

1658 / 1665

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Surgical Instruments
  • Mitral Valve Insufficiency
  • Middle Aged
  • Male
  • Humans
  • Hemodynamics
  • Heart Valve Prosthesis Implantation
  • Female
 

Citation

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Siegel, R. J., Biner, S., Rafique, A. M., Rinaldi, M., Lim, S., Fail, P., … EVEREST Investigators. (2011). The acute hemodynamic effects of MitraClip therapy. J Am Coll Cardiol, 57(16), 1658–1665. https://doi.org/10.1016/j.jacc.2010.11.043
Siegel, Robert J., Simon Biner, Asim M. Rafique, Michael Rinaldi, Scott Lim, Peter Fail, James Hermiller, et al. “The acute hemodynamic effects of MitraClip therapy.J Am Coll Cardiol 57, no. 16 (April 19, 2011): 1658–65. https://doi.org/10.1016/j.jacc.2010.11.043.
Siegel RJ, Biner S, Rafique AM, Rinaldi M, Lim S, Fail P, et al. The acute hemodynamic effects of MitraClip therapy. J Am Coll Cardiol. 2011 Apr 19;57(16):1658–65.
Siegel, Robert J., et al. “The acute hemodynamic effects of MitraClip therapy.J Am Coll Cardiol, vol. 57, no. 16, Apr. 2011, pp. 1658–65. Pubmed, doi:10.1016/j.jacc.2010.11.043.
Siegel RJ, Biner S, Rafique AM, Rinaldi M, Lim S, Fail P, Hermiller J, Smalling R, Whitlow PL, Herrmann HC, Foster E, Feldman T, Glower D, Kar S, EVEREST Investigators. The acute hemodynamic effects of MitraClip therapy. J Am Coll Cardiol. 2011 Apr 19;57(16):1658–1665.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

April 19, 2011

Volume

57

Issue

16

Start / End Page

1658 / 1665

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Surgical Instruments
  • Mitral Valve Insufficiency
  • Middle Aged
  • Male
  • Humans
  • Hemodynamics
  • Heart Valve Prosthesis Implantation
  • Female