Different indicators for postprocedural mitral stenosis caused by single- or multiple-clip implantation after percutaneous mitral valve repair

Background: Postprocedural mitral stenosis (MS) is a main limitation for MitraClip (TM) (Abbot Vascular, Inc., Santa Clara, CA, USA) procedure. The purpose of this study was to detect the preprocedural predictors of high transmitral pressure gradient (TMPG) after MitraClip (TM) implantation, which indicated postprocedural mitral stenosis (MS). Methods: We studied 79 patients who were implanted with MitraClip (TM) in our institute. Before the procedure, mitral valve orifice area (MVOA), and anterior-posterior (AP) and medial-lateral (ML) mitral annular diameters were measured at diastole using three-dimensional (3D) transesophageal echocardiography (TEE) data set. After the procedure, the mean TMPG was assessed using continuous-wave (CW) Doppler by periprocedural TEE. Results: Preprocedural MVOA, and AP and ML diameter of left ventricular (LV) inflow orifices were larger in patients with mean TMPG <= 4 mmHg than in patients with TMPG >4 mmHg after 1- and 2-clip implantation. The large MVOA and ML diameter of LV inflow orifice strongly correlated with the low TMPG after 1- and 2-clip implantation. As a result of the receiver operating characteristic curve analysis, the preprocedural MVOA predicted the low postprocedural TMPG more accurately than the ML diameter of LV inflow orifice after 1-clip implantation either in the degenerative or functional mitral regurgitation (MR) patients. After 2-clip implantation, however, the preprocedural ML diameter of LV inflow orifice predicted it more accurately than the MVOA in the degenerative and functional MR patients. Conclusions: 3D TEE derived MVOA predicts the postprocedural MS after 1-clip implantation, however, preprocedural ML diameter of LV inflow orifice is more useful to predict after 2-clip implantation. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.