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  • Title: Left atrial pressure and predictors of survival after percutaneous mitral paravalvular leak closure.
    Author: Maor E, Raphael CE, Panaich SS, Alkhouli M, Cabalka A, Hagler DJ, Pollak PM, Reeder GS, Eleid MF, Rihal CS.
    Journal: Catheter Cardiovasc Interv; 2017 Nov 01; 90(5):861-869. PubMed ID: 28707362.
    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 (<25%; 25-30%; >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.
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