The following is the summary of “Anesthesia-Induced Intraprocedural Downgrading of Mitral Regurgitation During Transcatheter Edge-to-Edge Repair” published in the March 2023 issue of Cardiovascular Disease by Ingallina, et al.
Functional mitral regurgitation (FMR) severity is often seen to decrease with transcatheter edge-to-edge repair (TEER) in comparison to pre-treatment examination. Intraprocedural downgrading (ID) of regurgitation severity may impact both the technique employed throughout the procedure and the final outcome because of how much emphasis is placed on the position and intensity of the regurgitant jets. The purpose of this research was to compare early and midterm results between patients with and without ID during TEER by assessing the prevalence of ID.
The participants of this single-center, retrospective study included all patients with moderate-to-severe or severe FMR who had TEER at San Raffaele Hospital between 2018 and 2020. During the intraoperative examination, ID was classified as having a mild (1+) or moderate (2+) degree of regurgitation. All-cause mortality, hospitalization for heart failure, and recurrence of mitral regurgitation (>2+) were measured at discharge and over the subsequent 2 years of follow-up. 55 patients made up the study’s final cohort; 42% of them had ID. Patients with ID were more likely than those without ID to have their regurgitation reduced to (2+) or less before discharge (P<0.009). There was no statistically significant difference between patients with and without ID regarding all-cause mortality, hospitalization for heart failure, or recurrence of mitral regurgitation (>2+) at 2 years.
Thus, it is safe to assume that ID frequently occurs during TEER in FMR. No distinguishing features at baseline could be used to classify these patients. Live intraprocedural imaging in conjunction with baseline ambulatory measurement of regurgitant jets appears to be a useful method is guidance for a successful and long-lasting mitral repair in patients with ID.
Source: sciencedirect.com/science/article/abs/pii/S0002914922012620