Impact of interventional edge-to-edge repair on mitral valve geometry

Background/objectives: The acute and long-term effects of interventional edge-to-edge repair on the mitral valve (MV) geometry are unclear. We sought to assess MV-annular geometry and the association of changes in MV-diameters with functional response one year after MitraClip implantation. Methods: Consecutive patients (n= 84; age 81.2 +/- 8.3 years, logistic EuroSCORE 21.7 +/- 17.9%) with symptomatic moderate-to-severe mitral regurgitation (MR) underwent MitraClip-procedure. MV-annular geometry was assessed with 3D TOE before, immediately and one year after clip implantation. Results: 96.7% of secondary mitral regurgitation (SMR) patients presented with moderate-to-severe MR, 3.3% with severe SMR, respectively. 66.7% of primary MR (PMR) patients had moderate-to-severe MR, and 33.3% severe PMR respectively. When analyzing immediate effects of MitraClipC on mitral geometry, only patients with SMR (n = 60, 71.4%) experienced significant reductions of the diastolic MV anterior-posterior diameters (AP: 3.9 +/- 0.5 cm, 3.5 +/- 0.7 cm; p < 0.001), and annulus-areas (2D: 12.9 +/- 3.8 cm2, 12.6 +/- 3.7 cm2; p < 0.001; 3D: 13.4 +/- 3.8, 13.1 +/- 3.2 cm2; p < 0.001). All measures on MV annular geometry were not significantly altered in patients with PMR (p N 0.05). After one year of follow-up, MV annular parameters remained significantly reduced in SMR patients (p < 0.05) and remained unchanged in subjects with PMR (p N 0.05). Only SMR patients experienced significant increase in 6 min walking distances (p= 0.004), decrease in pulmonary pressures (p = 0.007) and functional NYHA-class (p < 0.001); in patients with PMR only NYHA class improved after one year (p < 0.001). Conclusion: Edge-to-edge repair with the MitraClip-systemimpacts on MV-geometry in patients with SMR with stable results after 12 months. Reduction of MV-annular dimensions was associated with higher rates of persisting MR reduction and better functional status in patients with SMR. (C) 2016 Elsevier Ireland Ltd. All rights reserved.