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Thesis etd-03152012-124646


Thesis type
Tesi di specializzazione
Author
DONATI, FRANCESCA
URN
etd-03152012-124646
Thesis title
Influenza della MitraClip sulla funzione ventricolare destra
Department
MEDICINA E CHIRURGIA
Course of study
CARDIOLOGIA
Supervisors
relatore Prof. Balbarini, Alberto
Keywords
  • ecocardiogramma
  • mitraclip
  • ventricolo destro
Graduation session start date
02/04/2012
Availability
Full
Summary
Aims: Patients with severe mitral regurgitation (MR) at high surgical risk can undergo percutaneous mitral valve repair with the Mitraclip device, yielding good results in terms of quality of life, reduction of MR and improvement of left ventricular (LV) function. Our aim was to assess the changes in right ventricular (RV) function after Mitraclip implantation.
Methods and Results:
Between November 2009 and January 2012, we assessed LV and RV function in all consecutive patients undergoing Mitraclip implantation by means of transthoracic echocardiography. All patients underwent clinical and echocardiographic follow-up at 1, 3 and 6 months. Changes in echocardiographic parameters during follow-up were evaluated with repeated measures ANOVA.
Thirty-four consecutive patients (74±9 years; 23 men, 67.6%), with functional (79.4%, 27 patients) or degenerative MR (20.6%, 7 patients) were enrolled. Mean logistic EuroSCORE was 32±26%. Baseline functional status was severely impaired, as assessed by NYHA class (91.2% of patients in NYHA class >2), Minnesota test (MHFLQ score 58±20) and Six Minute Walking Test (SMWT 359±161 meters). LV ejection fraction (EF%) was 38±11%, while the systolic myocardial velocity at the lateral mitral annulus (S’ wave) assessed by Tissue Doppler Imaging (TDI) was 5.8±1.6 cm/sec. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE, 17.2±3.6 mm), RV systolic myocardial velocity at the tricuspid annulus by TDI ( 9.6±3.1 cm/sec), and pulmonary artery systolic pressure (PAPs, 48.6±10.4 mmHg).
Acute device success was achieved in 34 (100%) patients. Most patients received a single clip (73.5%), while 2 clips were deployed in 26.5%. At 1-month follow-up, 3 patients experienced partial clip detachment, and 1 of these underwent a second MitraClip procedure because of persistent grade 3 MR. Overall mortality was 0% in-hospital, 2.9% at 1 month, and 8.8% at 3, 6 months.
After Mitraclip implantation MR improved significantly, with 9%, 14% and 12% of patients with MR > grade 2+ at 1, 3 and 6 months, respectively (P<0.0001). We also observed a marked clinical benefit with 9.0%, 14.1% and 12.0% of patients in NYHA class >2 at 1, 3 and 6 months, respectively (P<0.0001). MHFLQ score decreased to 35±16, 36±17, and 37±17, respectively (P=0.005); SMWT increased to 424±167 , 446±165, and 620±168 meters, respectively (P=0.05).
Concerning echocardiographic data, LV ejection fraction increased to 41±12%, 42±12% and 46±12% at 1, 3 and 6 months, respectively (P=0.04); LV TDI S’ wave increased to 7.5±1.7, 7.4±1 and 7.6±2.8 cm/s, respectively (P=0.03). With regards to RV function, PAPs significantly decreased to 39.4±7.4 mmHg, 35.8±6.1 mmHg, and 37.3±9.5 mmHg, respectively (P=0.002), while TAPSE increased to 19.0±3.4, 19.5±3.2, 19.9±2.9 mm, respectively (P=0.05). Finally, no significant changes in RV TDI S’ wave were observed, with values of 12.2±4.7, 13.2±5.7, 12.0±4.2 cm/s, respectively (P=0.59). No differences in RV function changes was seen between degenerative and functional MR groups.
Conclusion:
MitraClip implantation is associated with a significant improvement in RV function and with a reduction in PAPs, in addition to the already known benefits in terms of quality of life, functional status, and improvement in LV function.
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