Impact of mitral clip implantation on left atrial appendage velocity
Jain T, Wang DD, Abdelrahim E, Gorgis S, Eng M, Nemeh H, O'Neill W, Greenbaum A. Impact of mitral clip implantation on left atrial appendage velocity. J Am Soc Echocardiogr. 2017;30(6):B39.
J Am Soc Echocardiogr
Background: Previous studies have demonstrated the feasibility of mitral clip to improve safety and achieve similar clinical outcomes compared to surgical mitral valve repair in high risk surgical patients with severe mitralregurgitation. Transesophageal echocardiogram (TEE) plays an integral role in planning of a successful procedure. Leftatrial appendage (LAA) velocity serves as a marker of LAA function. However, there is no data about the impact ofmitral clip procedure on the LAA function and velocity. We sought to assess the impact of mitral clip procedure on pre and post-procedure LAA velocity as assessed by intra-procedural TEE. Methods: We evaluated a total of 29 patients with severe mitral regurgitation who were poor surgical candidates for mitral valve surgery and thus underwent mitral clip procedure between July 2015 to December 2016. Baseline demographics and intra-procedure TEE data was obtained and patients were followed for 30-days clinical outcomes. Mitral regurgitation (MR) severity was graded as (1=mild, 2=moderate, 3=moderate-severe, 4=severe). Results: Among the 29 patients, 70% were females and the mean age at the time ofprocedure was 78.5 years. The mean Society of Thoracic Surgeons mortality risk score was 8.3%. 18 (62%) patients had pre-existing atrial fibrillation or flutter with mean CHA2DS2-VASc score of 5.5. All patients had pre-existing grade 4 MR which was reduced to grade 1 in 20/29 and grade 2 in 5/29 patients after the procedure. There was a significant decrease in LAA velocity after the procedure (39.1± 17.8 cm/sec vs 27.11 ± 11.9 cm/sec, p = 0.001). In 4 patients, the post-procedure LAA velocity was higher compared to the pre-procedure LAA velocity and they had residual grade 3 MR which was eccentric in nature. There were a total of 2 non-cardiac related deaths at 30 days with no cases of post-procedure stroke. At 30-days, NYHA class improved from III/IV to I/II (p<0.05). Conclusion: Mitral clipimplantation was associated with significant decrease in the post-procedure LAA velocity which may in turn serve as a marker of procedural success as demonstrated by more pronounced improvement in MR grade and improved NYHA class at 30-days follow-up. Larger studies with longer follow-up are needed to assess the long-term clinical impact ofchange in LAA velocity over time.