Risk of Increased Mean Diastolic Gradient After Transcatheter Edge-to-Edge Mitral Valve Repair: A Quantitative 3D TEE Analysis

ABSTRACT Background Iatrogenic mitral stenosis is a known limitation of transcatheter edge-to-edge mitral valve repair(TMVr), but determinants of increased post-procedure mean diastolic gradient(MG) are not well defined. We sought to determine correlates of increased post-TMVr MG or aborted clip implantation due to increased MG. Methods Procedural 3D transesophageal echocardiographic(TEE) datasets of 112 patients who underwent TMVr were retrospectively analyzed. 3D TEE-derived mitral valve area(MVA) planimetry and mitral annular calcification(MAC) were quantified using multiplanar reconstruction. When MAC extension into the mitral leaflets was present, the MAC with leaflet calcification(MAC-LC) length was recorded as the maximum distance from the mitral annulus to the most distal leaflet calcification. Increased MG post-TMVr, measured by intraprocedural TEE, was defined as ≥5mmHg or aborted clip implantation due to increased MG. Results Baseline MVA was 5.9±1.7 cm2, baseline mean gradient was 2.1±1.2 mmHg, and MAC-LC length was 4.0±4.5mm. 32 patients(29%) had increased post-TMVr MG. Risk of increased post-TMVr MG was 86%, 28%, and 14% in patients with baseline MVA 6.0cm2, respectively (p 6.0cm2, the risk of increased post-TMVr MG was similar in the presence or absence of baseline MG ≥4mmHg or MAC-LC ≥6mm(p>0.05 for both). Conclusions Patients with a baseline 3D TEE-derived MVA