Continuous invasive hemodynamic monitoring using steerable guide catheter to optimize mitraclip transcatheter mitral valve repair: A multicenter, proof‐of‐concept study
Gilbert H. L. Tang, Lawrence Y. Ong, Ryan Kaple, Basel Ramlawi, Tanya Dutta, Syed Zaid, Hasan Ahmad, Robert Kalimi, Cenap Undemir, Asaad Khan, Matias B. Yudi, M. Adnan Nadir, Farhan Majeed, Omar Ali, Jeffrey Skiles, Chandra Bhim, Martin Cohen, Steven L. Lansman, Samin K. Sharma, Annapoorna Kini
Source abstract
Objectives We report our multicenter experience on continuous hemodynamic monitoring using exclusively the steerable guide catheter (SGC) during MitraClip repair. Background Left atrial pressure (LAP) and V‐wave are useful to evaluate MitraClip repair but no simple method of continuous monitoring exists. Methods From 11/2016 to 8/2017, 74 patients from four centers with symptomatic moderate‐severe to severe mitral regurgitation (MR), underwent MitraClip NT repair with continuous hemodynamic monitoring via the SGC. Real‐time LAP/V‐wave changes were compared with transesophageal echocardiography (TEE). When mitral stenosis was suspected, transmitral gradients were verified by invasive hemodynamics. Clinical and echocardiographic outcomes were determined. Results Mean age was 78 ± 10 years and STS score 9.1 ± 11.0%. Pathology included leaflet prolapse/flail (45%), restriction (35%), and mixed (20%). Number of clips averaged 1.7 ± 0.7 per case. There was a significant reduction in LAP (21 ± 10 to 15 ± 7 mmHg, P < 0.0001) and V‐wave(37 ± 19 to 24 ± 10 mmHg, P < 0.0001) post MitraClip, but the decrease was less in patients with atrial fibrillation ( P < 0.05). Transmitral gradient significantly increased from 2.0 ± 1.2 to 4.0 ± 1.7 mmHg ( P < 0.0001). Paradoxical increases in LAP and V‐wave despite MR reduction were observed in three cases requiring MitraClip repositioning or retrieval to avoid stenosis. Follow‐up averaged 5.0 ± 2.9 months and was 100% complete. KCCQ improvement was significant and MR reduction to < 1+ was 67% and < 2+ was 93% at 30 days. Conclusions Continuous hemodynamic monitoring using the SGC complements TEE to assess and optimize MitraClip repair in real‐time. Further validation is necessary but this feature may be part of future MitraClip and other transcatheter mitral repair systems.
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