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  • Title: Impact of the Leaflet-to-Annulus Index on Residual Mitral Regurgitation in Patients Undergoing Edge-to-Edge Mitral Repair.
    Author: Tabata N, Weber M, Sugiura A, Öztürk C, Ishii M, Tsujita K, Nickenig G, Sinning JM.
    Journal: JACC Cardiovasc Interv; 2019 Dec 23; 12(24):2462-2472. PubMed ID: 31857016.
    Abstract:
    OBJECTIVES: This study sought to investigate the clinical impact of leaflet-to-annulus mismatch on residual mitral regurgitation (MR) after percutaneous edge-to-edge mitral repair. BACKGROUND: Annular dilation is a common feature of secondary MR, which requires concomitant annuloplasty in surgical mitral valve repair. METHODS: Consecutive MR patients undergoing MitraClip (Abbott Vascular, Santa Clara, California) implantation in the Heart Center Bonn were enrolled. Residual MR was defined as a post-procedural MR ≥2+ and patients were stratified into 2 groups according to the residual MR. The study calculated the leaflet-to-annulus index (LAI) using pre-procedural 2- and 3-dimensional transesophageal echocardiography. All-cause death within a 1-year follow-up was examined. RESULTS: Of 420 consecutive patients, 117 (27.9%) patients had residual MR (≥2+). Patients with residual MR had a significantly lower pre-procedural LAI than did those with MR <2+ (median 1.14 [interquartile range (IQR): 1.07 to 1.20] vs. 1.18 [IQR: 1.12 to 1.29]; p < 0.001). A multivariable analysis revealed that the LAI value was significantly associated with residual MR (odds ratio: 0.95; p < 0.001). After 1-year follow-up, patients with residual MR had a significantly worse prognosis than did patients with MR <2+ (estimated mortality rate 17.4% vs. 7.3%; log-rank p = 0.002), and the presence of residual MR was independently correlated with 1-year mortality (hazard ratio: 2.74; p = 0.004). CONCLUSIONS: The LAI value is associated with residual MR after MitraClip implantation, which is independently correlated with 1-year mortality. This index might be a useful tool to identify patients with the need for concomitant annuloplasty before edge-to-edge repair.
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