Anatomical and Technical Predictors of Three-dimensional Mitral Valve Area Reduction after Transcatheter Edge-to-Edge Repair

Abstract Background Among current transcatheter therapies for the treatment of mitral regurgitation, the MitraClipTM (MC, Abbott Vascular, Illinois, USA) system is the most commonly used. MC implantation is usually contraindicated in patients with a mitral valve area (MVA) Methods Using 3D datasets, the annulus and leaflet anatomy, and MVA before clip implantation (MVABC) were assessed. After each MC implant (NTR or XTR), the relative MVA reduction and the absolute residual MVA were measured and their predictors evaluated. Results The present analysis included 116 patients. A MC XTR was the first device implanted in 50% of the subjects, and 53% were treated with a single implant. MVA reduction following one XTR was 57±7% vs. 52±8% after one NTR (p=0.001). A lower MVA reduction was observed when the MC was placed commissural/central versus paracentral (50±8 vs. 57±7%, p Conclusion The minimal native MVA preventing clinically relevant MS after transcatheter edge-to-edge repair is predicted by the number and location of clip(s), orifice morphology, and device type. Based on these parameters an algorithm has been derived to optimize patient selection and pre-procedural planning.