Use of Pleth Variability Index as a Non-invasive, Dynamic Indicator of Left Atrial Pressure Change During MitraClip: Transcatheter Mitral Valve Repair

Document Type

Article

Publication Date

9-1-2024

Publication Title

Seminars in cardiothoracic and vascular anesthesia

Abstract

BACKGROUND: Transcatheter edge-to-edge repair (TEER) with MitraClip is a safe and effective alternative to surgical mitral valve repair/replacement in patients with high operative risk. Pleth Variability Index (PVI) is a non-invasive, dynamic index based on analysis of the respiratory variations in the plethysmographic waveform recorded transcutaneously by the pulse oximeter.

OBJECTIVES: The objective of the study was to evaluate if the hemodynamic effect of improved left-sided output after successful transcatheter mitral valve repair would lead to a significant change in PVI, and if it would correlate with the decrease in left atrial pressure (LAP).

DESIGN: Prospective, observational cohort study (ClinicalTrials.gov NCT03993938).

SETTING: Single academic hospital in Detroit, Michigan (USA), from October 2019 to February 2021.

PARTICIPANTS: The authors included adult patients with severe mitral regurgitation who underwent successful MitraClip placement.

MEASUREMENTS AND MAIN RESULTS: Of 30 patients, all components of the LAP (a wave, v wave, and mean) decreased significantly after successful MitraClip placement (P < .01). The median (IQR) PVI increased from 21 (11-35) to 23 (13-38) after clip placement; however, this change was not statistically significant (P = .275). No significant correlation between change in PVI and change in LAP was observed (P = .235).

CONCLUSIONS: In patients with severe mitral regurgitation, successful MitraClip resulted in a significant reduction in LAP without a significant change in PVI. A larger sample size may provide more insight on the utility of using PVI as an indicator of LAP change in patients with mitral regurgitation.

Medical Subject Headings

Humans; Mitral Valve Insufficiency; Female; Prospective Studies; Male; Aged; Atrial Pressure; Cardiac Catheterization; Mitral Valve; Plethysmography; Cohort Studies; Aged, 80 and over; Heart Valve Prosthesis Implantation; Middle Aged

PubMed ID

38864441

ePublication

ePub ahead of print

Volume

28

Issue

3

First Page

147

Last Page

151

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