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Abstract 10566: Echocardiographic Predictors of Successful Transcatheter Mitral Valve Repair with the Mitraclip System


 Introduction:
 Residual mitral regurgitation (rMR) and elevated transmitral gradients (TMG) are associated with worse outcomes after percutaneous mitral repair. This study aims to assess if pre-intervention MR jet width and its relation to the mitral commissural length (MCL) are able to predict post-procedure rMR and TMG.
 
 
 Methods:
 Preprocedural echocardiographic images were retrospectively reviewed in 74 patients who underwent an edge-to-edge repair (2014-2018). Maximal MR jet width and MCL were measured from a bi-commissural view. Complete follow-up echocardiographic examination was performed at 1-3 months. Left ventricle (LV) and left atrial (LA) severe dilation were defined as LV end-diastolic diameter ≥6.5 cm and LA indexed volume ≥48 ml/m
 2
 . Presence of rMR ≥moderate, combination of rMR and TMG >5 mmHg (rMR+TMG), and all-cause mortality within 1-year follow-up were examined.
 
 
 Results:
 Of 74 patients, 25 (34%) had rMR [17/25 moderate and 8/25 severe)] and 39 (53%) had either rMR or elevated TMG. Both MR jet width and its ratio with MCL were good predictors for the implantation of >2 clips (p<0.01 for both). Patients with rMR had a significantly larger pre-procedural jet width versus those without MR (1.63±0.54 cm vs 1.29±0.53 cm; p=0.01); without significant difference for the ratio of jet width/MCL (p=0.07). However, this ratio was higher in patients having rMR+TMG (41.05±13.15 % vs 34.26±12.64 %; p=0.03). In univariate analysis, MR jet width was a good predictor of rMR (OR: 3.35, 95%CI: 1.09-10.48; p=0.03) and severe post-intervention LV (OR: 6.43, 95%CI: 1.35-45.01; p=0.03) and LA dilation (OR: 3.02, 95%CI: 1.16-8.69; p=0.03); whereas the ratio was a good predictor of rMR+TMG (OR: 1.69, 95%CI: 1.12-2.70; p=0.02). Patients with rMR and rMR+TMG tended to be at higher risk of mortality at one year, without reaching statistical significance in this small population (24% vs 14%, p=0.17 and 23% vs 11%, p=0.14 respectively).
 
 
 Conclusion:
 MR jet width and its ratio with MCL are respectively associated to rMR or combined rMR+TMG after percutaneous mitral repair. MR jet width was also useful to identify patients who remained with severe LV and LA dilatation post-intervention.
