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Gaemperli, O; Moccetti, M; Sürder, D; Biaggi, P; Hurlimann, D; Kretschmar, O; Buehler, I; Bettex, D; Felix, C; Luscher, T F; Falk, V; Grünenfelder, J; Corti, R (2012). Acute haemodynamic changes after percutaneous mitral valve repair: relation to mid-term outcomes. Heart, 98(2):126-132.

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Abstract

BackgroundPercutaneous mitral valve repair (MVR) using the Evalve MitraClip has been recently introduced as a potential alternative to surgical MVR.ObjectiveTo assess immediate haemodynamic changes after percutaneous MVR using right heart catheterisation.DesignSingle-centre longitudinal cohort study.SettingTertiary referral centre.PatientsFifty consecutive non-surgical patients (age 74±14 years, EuroSCORE 26±14) with moderate to severe (3+) and severe (4+) mitral regurgitation (MR) due to functional (56%), degenerative (30%) or mixed (14%) disease were selected.InterventionsMitraClip implantation was performed under general anaesthesia with fluoroscopy and echocardiographic guidance. Haemodynamic variables were obtained before and after MVR using standard right heart catheterisation and oximetry.Main outcome measuresHaemodynamic changes immediately before and after MVR.ResultsAcute procedural success (reduction in MR to grade 2+ or less) was achieved in 46 (92%) patients. Mitral valve clipping reduced mean pulmonary capillary wedge pressure (mPCWP) (from 17±7 to 12±5 mm Hg), PCWP v-wave (from 24±11 to 16±7 mm Hg) and mean pulmonary artery pressure (mPAP) (from 29±12 to 24±6 mm Hg), and increased the cardiac index (CI) (from 3.1±1.0 to 3.9±1.1 l/min/m(2)) (all p<0.05). On Cox univariate regression analysis, mPCWP, PCWP v-wave- and mPAP-changes were associated with death, open-heart surgery for MR and/or hospitalisation for heart failure on follow-up.ConclusionIn a heterogeneous population with predominantly functional MR, percutaneous MVR with the Evalve MitraClip system lowers mPCWP, PCWP v-wave and mPAP by 20%, 20% and 8%, respectively, and increases the CI by 32%.

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
DDC:610 Medicine & health
Language:English
Date:2012
Deposited On:08 Dec 2011 09:33
Last Modified:27 Nov 2013 22:16
Publisher:BMJ Publishing Group
ISSN:1355-6037
Publisher DOI:10.1136/heartjnl-2011-300705
PubMed ID:21983251
Citations:Web of Science®. Times Cited: 17
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Scopus®. Citation Count: 23

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