Invasive Hemodynamic Assessment of Cardiac Output State after MitraClip Therapy in Nonanaesthetized Patients with Functional Mitral Regurgitation
Abstrakt
Background. Surgical correction of mitral regurgitation (MR) can lead to postoperative low cardiac output state.
We aimed to assess the acute hemodynamic changes after percutaneous MitraClip therapy (a unique model without influence of factors linked to surgical procedure) in patients with functional MR without the influence of general anaesthesia. Methods.
We studied invasive hemodynamic parameters in 23 patients before procedure (conscious, nonsedated patients), during procedure (intubated patients), and the first day after MitraClip implantation (conscious, extubated patients). Results.
Mitral valve clipping significantly increased cardiac index (CI) (from 2.0 +/- 0.5 to 3.3 +/- 0.6 L/min/m(2); p < 0.01). Conversely, there was significant reduction in the mean pulmonary capillary wedge pressure (PCWP) (from 18.6 +/- 5.7 to 10.5 +/- 3.8 mm Hg; p < 0.01), mean pulmonary artery pressure (from 29.8 +/- 10.9 to 25.2 +/- 10.3 mm Hg; p = 0.03), and pulmonary vascular resistance index (from 531 +/- 359 to 365 +/- 193 dyn.s.cm(-5) /m(2); p = 0.03).
Conclusions. The functional MR therapy with percutaneous MitraClip device results in significant increase in CI (+66%) and concomitant decrease in PCWP (-42%).
None of our patients developed low cardiac output state. Our results support the idea that significant part of low cardiac output state after cardiac surgery is due to surgery related factors rather than due to increase in afterload after MR elimination.