Impact of acute hemodynamic effects on myocardial remodeling and mid-term durability after transcatheter edge-to-edge repair of mitral regurgitation using PASCAL®

HYPOTHESIS AND AIMS

Chronic mitral regurgitation (MR) causes hemodynamic changes, which lead to eccentric hypertrophy of the left ventricle and consecutively changes in right ventricular function.  This is followed by further myocardial remodeling. Reduction of MR using TEER leads to hemodynamic changes, which result in reversed cardiac remodeling: reduced left ventricular dilatation, improved left and right ventricular function with concomitant improvement of pulmonary hypertension. This project aims to investigate the periprocedural hemodynamic changes and their impact on myocardial remodeling and the durability of the device 6 to 12 months after a mitral valve TEER using the PASCAL system, stratified by primary and secondary MR.

METHODS AND RESULTS

In this single-center study, we retrospectively analyzed 75 consecutive patients with severe symptomatic primary or functional MR, who received a transcatheter mitral valve TEER. Several hemodynamic parameters (mean left atrial pressure (LA pressure), mean pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure (PAP mean) and cardiac index (CI)) were determined prior to and immediately after the mitral valve TEER. Transthoracic echocardiography was performed at baseline before the transcatheter mitral valve repair and after 6 to 12 months. The following echocardiographic parameters were collected, if available: LV global longitudinal strain (LV GLS), left ventricular ejection fraction (LVEF), parameters of right ventricular function (TAPSE and right ventricular fractional area change (RV FAC)), parameters of severity of MR, and durability of MR reduction. Furthermore, laboratory values (NTpro-BNP, GFR, albumin, liver enzymes) before the intervention were compared to the values on follow-up in order to objectivize the degree of decompensation.

As result, TEER led to a significant reduction of LA Pressure and PCWP in both patients with primary MR and patients with secondary MR.  There was also a non-significant average increase of CI in patients with primary and secondary MR. This increase was stronger in patients with secondary MR. When looking at the whole cohort, there was a significant improvement of LV GLS. A numeric but not significant increase was found in patients with primary MR. In patients with secondary MR, TEER led to a significant improvement of not only LV GLS, but also of LVEF and RV FAC.

Table 1 Comparison of hemodynamic parameters before and after TEER

Table 2 Comparison of echocardiographic parameters before and after TEER

CONCLUSIONS

In summary, TEER using a PASCAL system led to an improvement of left and right ventricular function with corresponding hemodynamic improvements, especially in patients with secondary MR. These observations indicate immediate beneficial effects of TEER on cardiac function resulting in reverse cardiac remodeling.