Left atrial pressure and predictors of survival after percutaneous mitral paravalvular leak closure.

Published on Jul 14, 2017in Catheterization and Cardiovascular Interventions2.044
· DOI :10.1002/CCD.27179
Elad Maor21
Estimated H-index: 21
(Mayo Clinic),
Claire E. Raphael14
Estimated H-index: 14
(Mayo Clinic)
+ 7 AuthorsCharanjit S. Rihal96
Estimated H-index: 96
(Mayo Clinic)
Sources
Abstract
Background Data on the clinical utility of left atrial (LA) hemodynamic monitoring during percutaneous mitral interventions are limited. Objectives To evaluate the association between intraprocedural LA pressures during percutaneous mitral paravalvular leak (PVL) closure and long term survival. Methods Patients who underwent mitral PVL repair with invasive LA pressure monitoring were divided at baseline to three tertiles based on their mean final LA pressure ( 30% of mean systolic blood pressure). Primary outcome was all-cause mortality. Results 134 patients (mean age 68 ± 12 years) were studied. Over 3 year mean follow-up, 81 (38%) patients died. The cumulative probability of death at 3 years was significantly higher among patients in the highest LA pressure tertile (56 ± 8% vs. 28 ± 5%, log rank P < 0.001). More than mild residual mitral regurgitation (MR) by transesophageal echocardiography (TEE) was associated with a 2.5-fold increased risk of death and patients in the highest LA pressure tertile had 2.2-fold higher mortality (P < 0.001 and = 0.003 respectively). After adjustment for residual MR by TEE, each 10% acute procedural reduction in LA pressures was associated with a significant 9% reduced risk of death (P = 0.023). Multivariate Cox regression with adjustment for multiple predictors of death showed that patients in lower LA pressure tertiles had 59% lower mortality (P = 0.003). Conclusion Lower LA pressure following mitral PVL closure is an independent predictor of improved survival, even after adjustment for residual MR. LA pressure monitoring may be a useful tool for procedural guidance during mitral PVL closure.
📖 Papers frequently viewed together
7 Citations
References17
Newest
#1Elad Maor (Mayo Clinic)H-Index: 21
#2Claire E. Raphael (Mayo Clinic)H-Index: 14
Last. Mackram F. Eleid (Mayo Clinic)H-Index: 33
view all 8 authors...
Background—Data on the clinical use of left atrial (LA) hemodynamic monitoring during MitraClip procedure are limited. This study evaluated the association between intraprocedural changes in LA pre...
36 CitationsSource
#1Patrick A. Calvert (University of Birmingham)H-Index: 19
#2David NorthridgeH-Index: 3
Last. David Hildick-Smith (Brighton and Sussex University Hospitals NHS Trust)H-Index: 66
view all 33 authors...
Background —Paravalvular leak (PVL) occurs in 5-17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery. Methods —All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry. Data was analyzed for association with death and major adverse cardiovascular events (MACE) at follow up. Results —308 PVL closure procedures were attempted in 259 patients in 20 centers (2004-2015). Patient age w...
53 CitationsSource
#1Mohammad Sarraf (Mayo Clinic)H-Index: 7
#2Mohamad Alkhouli (Mayo Clinic)H-Index: 24
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 11 authors...
1 CitationsSource
#1Mackram F. Eleid (Mayo Clinic)H-Index: 33
#2Saurabh Sanon (Mayo Clinic)H-Index: 11
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 5 authors...
We describe the novel use of continuous left atrial pressure (LAP) monitoring to guide the MitraClip (Abbott Vascular, Santa Clara, California) procedure. In addition to transesophageal echocardiography, we have found that direct measurement of LAP is also a useful tool to determine the hemodynamic
21 CitationsSource
#1Xavier Millán (MHI: Montreal Heart Institute)H-Index: 8
#2Sabah Skaf (MHI: Montreal Heart Institute)H-Index: 2
Last. E. Marc Jolicœur (MHI: Montreal Heart Institute)H-Index: 7
view all 15 authors...
Abstract Background Significant paravalvular leak (PVL) after surgical valve replacement can result in intractable congestive heart failure and hemolytic anemia. Because repeat surgery is performed in only few patients, transcatheter reduction of PVL is emerging as an alternative option, but its safety and efficacy remain uncertain. In this study we sought to assess whether a successful transcatheter PVL reduction is associated with an improvement in clinical outcomes. Methods We identified 12 c...
56 CitationsSource
#1Rick A. NishimuraH-Index: 128
#2Catherine M OttoH-Index: 85
Last. James D. Thomas (American Society of Echocardiography)H-Index: 137
view all 12 authors...
Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN, FAHA, Biykem Bozkurt, MD, PhD, FACC, FAHA, Ralph G. Brindis, MD, MPH, MACC, Mark A. Creager, MD, FACC, FAHA[§§][1], Lesley H. Curtis, PhD, FAHA, David DeMets, PhD,
1,705 CitationsSource
#1Paul Sorajja (Mayo Clinic)H-Index: 39
#2Allison K. Cabalka (Mayo Clinic)H-Index: 30
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 4 authors...
Objectives This study sought to assess the learning curve for percutaneous repair of paravalvular prosthetic regurgitation. Background Percutaneous repair of prosthetic paravalvular regurgitation is a complex procedure. There is a paucity of data on the professional experience and tools needed to achieve optimal clinical outcomes. Methods We examined the chronological experience of 200 patients (age 66 ± 13 years; 57% men) who underwent percutaneous closure of paravalvular prosthetic regurgitati...
47 CitationsSource
#1Charanjit S. Rihal (Mayo Clinic)H-Index: 96
#2Paul Sorajja (Mayo Clinic)H-Index: 39
Last. Allison K. Cabalka (Mayo Clinic)H-Index: 30
view all 5 authors...
Paravalvular regurgitation affects 5% to 17% of all surgically implanted prosthetic heart valves. Patients who have paravalvular regurgitation can be asymptomatic or present with hemolysis or heart failure, or both. Reoperation is associated with increased morbidity and is not always successful because of underlying tissue friability, inflammation, or calcification. Comprehensive echocardiographic imaging with transthoracic and real-time 3-dimensional transesophageal echocardiography is key for ...
126 CitationsSource
#1Paul Sorajja (Mayo Clinic)H-Index: 39
#2Allison K. Cabalka (Mayo Clinic)H-Index: 30
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 4 authors...
Objectives The goal of this study was to determine the long-term clinical efficacy of percutaneous repair of paravalvular prosthetic regurgitation. Background Percutaneous repair has emerged as an effective therapy for patients with paravalvular prosthetic regurgitation. Methods We retrospectively identified 126 patients who underwent catheter-based treatment of symptomatic prosthetic paravalvular regurgitation. Patients were contacted for symptoms, clinical events, and vital status. Results The...
150 CitationsSource
Objectives The purpose of this study was to evaluate the feasibility and efficacy of the percutaneous device closure of a consecutive series of patients with periprosthetic paravalvular leaks referred to our structural heart disease center with congestive heart failure and hemolytic anemia. Background Clinically significant periprosthetic paravalvular leak is an uncommon but serious complication after surgical valve replacement. Percutaneous closure has been utilized as an alternative to surgica...
230 CitationsSource
Cited By8
Newest
Paravalvular leak (PVL) represents a suboptimal procedural outcome resulting in an eccentric regurgitant jet following surgical or transcatheter aortic or mitral valve replacements. In this review, the role of integrated imaging modalities, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, for the diagnosis and evaluation of aortic and mitral PVL is comprehensively discussed. Interventional procedures ...
Source
#1James W. Lloyd (Mayo Clinic)H-Index: 3
#2Charanjit S. Rihal (Mayo Clinic)H-Index: 96
Last. Mackram F. Eleid (Mayo Clinic)H-Index: 33
view all 3 authors...
Mitral valvulopathy presents as regurgitation, stenosis, or mixed disease and can occur in both native and prosthetic valves. Such disease develops in conjunction with pathophysiologic changes in the left atrium (LA) and drives changes in LA compliance, pressure, and thus clinical syndromes. With advances in the understanding and treatment of structural heart disease and in the setting of higher-risk patient populations, less-invasive transcatheter approaches have become increasingly commonplace...
1 CitationsSource
#1Mohammed Al-Hijji (Mayo Clinic)H-Index: 12
#2Abdallah El Sabbagh (Mayo Clinic)H-Index: 13
Last. Mackram F. Eleid (Mayo Clinic)H-Index: 33
view all 5 authors...
BACKGROUND: Treatment of hemodynamically significant mitral annular calcification (MAC) using transcatheter approaches is in the early learning phase. The occurrence of paravalvular leak (PVL) following transcatheter mitral valve in MAC is common. AIMS: To report the initial experience and techniques of percutaneous PVL closure after transcatheter valve in MAC. METHODS: This series includes five consecutive patients who underwent percutaneous PVL closure following transcatheter balloon expandabl...
4 CitationsSource
#1James W. Lloyd (Mayo Clinic)H-Index: 3
#2Timothy A. Joseph (Mayo Clinic)H-Index: 3
Last. Mackram F. Eleid (Mayo Clinic)H-Index: 33
view all 6 authors...
OBJECTIVE: To understand the clinical and hemodynamic response of patients with stenotic versus regurgitant prosthetic mitral valve degeneration to transseptal transcatheter mitral valve-in-ring/-valve replacement (TMVR). BACKGROUND: Patients with prosthetic mitral valve repair/replacement failure frequently present high-risk surgical challenges. TMVR has been employed as an alternative to surgery. METHODS: Forty-four patients with stenotic/regurgitant degeneration of prior prosthetic mitral ann...
5 CitationsSource
#1Timothy A. Joseph (Mayo Clinic)H-Index: 3
#2Colleen E. Lane (Mayo Clinic)H-Index: 2
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 5 authors...
ABSTRACTIntroduction: Significant paravalvular leak (PVL) complicates between 6% and 15% of valve replacements and can result in heart failure and hemolysis. Paravalvular leak can be effectively treated with repeat surgery; however, these procedures are associated with significant operative morbidity. Percutaneous PVL closure is increasingly being utilized as the first line therapy for symptomatic patients, but efficacy may be limited by the lack of dedicated closure devices.Areas covered: This ...
5 CitationsSource
#1Ahmit Gupta (University of Texas at Austin)H-Index: 1
#2Steven R. Bailey (University of Texas at Austin)H-Index: 10
Last. Steven R. Bailey (University of Texas at Austin)H-Index: 46
view all 2 authors...
Purpose of Review This article provides an update on percutaneous devices to treat diastolic dysfunction, current clinical experience, and actively enrolling trials. We also discuss potential complications and limitations of devices.
4 CitationsSource
#1Mackram F. Eleid (Mayo Clinic)H-Index: 33
### Learning objectives Paravalvular leak (PVL) is a common and underdiagnosed condition affecting both surgical and transcatheter prosthetic heart valves.1–3 Characterised by a gap between the prosthetic valve and the native annular tissue, PVL results in regurgitation of blood from downstream to upstream chamber, occurring most often in conditions of tissue friability such as endocarditis, frailty, corticosteroid use, prior surgical valve replacement and/or in the setting of severe annular cal...
4 CitationsSource
#1Kashish Goel (Mayo Clinic)H-Index: 26
#2Mackram F. Eleid (Mayo Clinic)H-Index: 33
Purpose of Review This review will summarize the growing importance of diagnosing and managing paravalvular leak associated with surgical and transcatheter valves.
9 CitationsSource