TY - JOUR
T1 - Systematic Fluoroscopic-Echocardiographic Fusion Imaging Protocol for Transcatheter Edge-to-Edge Mitral Valve Repair Intraprocedural Monitoring
AU - Melillo, Francesco
AU - Fisicaro, Andrea
AU - Stella, Stefano
AU - Ancona, Francesco
AU - Capogrosso, Cristina
AU - Ingallina, Giacomo
AU - Maccagni, Davide
AU - Romano, Vittorio
AU - Ruggeri, Stefania
AU - Godino, Cosmo
AU - Latib, Azeem
AU - Montorfano, Matteo
AU - Colombo, Antonio
AU - Agricola, Eustachio
N1 - Publisher Copyright:
© 2021 American Society of Echocardiography
PY - 2021/6
Y1 - 2021/6
N2 - Background: Whether fluoroscopic-echocardiographic fusion imaging (FI) might offer added value for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair is yet unknown, and few data exist regarding the safety and feasibility of this novel technology. Methods: The aim of this single-center study was to test and validate a FI protocol for intraprocedural monitoring of transcatheter edge-to-edge mitral valve repair and assess its clinical usefulness. Eighty patients underwent MitraClip implantation using FI guidance (FI+) for either degenerative (35%) or functional (65%) mitral regurgitation and were compared with the last 80 patients before FI introduction, treated using conventional echocardiography and fluoroscopic monitoring (FI−). Results: The number of patients treated for functional and degenerative mitral regurgitation was similar between the FI+ and FI− groups, as well as the number of devices implanted (1.51 ± 0.5 vs 1.58 ± 0.6, P =.46). The prevalence of complex mitral anatomy for percutaneous repair was high (32.5%, up to 39.2% in the hybrid arm). Fluoroscopy time was significantly lower in FI+ patients (37.3 ± 14.6 vs 48.3 ± 28.3 min, P =.003), but not kerma area product (91.5 ± 74.1 vs 108.8 ± 105.0 Gy · cm2, P =.23) or procedural time (92.2 ± 36.1 vs 103.1 ± 42.7 min, P =.086). After adjusting for confounding factors (MitraClip XT device and complex anatomy), FI reduced fluoroscopy time (coefficient = −10.4 min; 95% CI, −18.03 to −2.82; P =.007) and improved procedural success at the end of the procedure (odds ratio, 2.87; 95% CI, 1.00 to 8.24; P =.049) and discharge (odds ratio, 2.24; 95% CI, 1.04 to 4.80; P =.039). Rates of periprocedural complications were similar in both groups (8.9% vs 13.0%, P =.40). Conclusions: The authors describe the systematic use of an FI protocol for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair, demonstrating a reduction in fluoroscopy time and an improvement in procedural success in a population with a high prevalence of challenging mitral anatomy for percutaneous repair.
AB - Background: Whether fluoroscopic-echocardiographic fusion imaging (FI) might offer added value for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair is yet unknown, and few data exist regarding the safety and feasibility of this novel technology. Methods: The aim of this single-center study was to test and validate a FI protocol for intraprocedural monitoring of transcatheter edge-to-edge mitral valve repair and assess its clinical usefulness. Eighty patients underwent MitraClip implantation using FI guidance (FI+) for either degenerative (35%) or functional (65%) mitral regurgitation and were compared with the last 80 patients before FI introduction, treated using conventional echocardiography and fluoroscopic monitoring (FI−). Results: The number of patients treated for functional and degenerative mitral regurgitation was similar between the FI+ and FI− groups, as well as the number of devices implanted (1.51 ± 0.5 vs 1.58 ± 0.6, P =.46). The prevalence of complex mitral anatomy for percutaneous repair was high (32.5%, up to 39.2% in the hybrid arm). Fluoroscopy time was significantly lower in FI+ patients (37.3 ± 14.6 vs 48.3 ± 28.3 min, P =.003), but not kerma area product (91.5 ± 74.1 vs 108.8 ± 105.0 Gy · cm2, P =.23) or procedural time (92.2 ± 36.1 vs 103.1 ± 42.7 min, P =.086). After adjusting for confounding factors (MitraClip XT device and complex anatomy), FI reduced fluoroscopy time (coefficient = −10.4 min; 95% CI, −18.03 to −2.82; P =.007) and improved procedural success at the end of the procedure (odds ratio, 2.87; 95% CI, 1.00 to 8.24; P =.049) and discharge (odds ratio, 2.24; 95% CI, 1.04 to 4.80; P =.039). Rates of periprocedural complications were similar in both groups (8.9% vs 13.0%, P =.40). Conclusions: The authors describe the systematic use of an FI protocol for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair, demonstrating a reduction in fluoroscopy time and an improvement in procedural success in a population with a high prevalence of challenging mitral anatomy for percutaneous repair.
KW - 3D echocardiography
KW - Fusion imaging
KW - Percutaneous mitral valve repair
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U2 - 10.1016/j.echo.2021.01.010
DO - 10.1016/j.echo.2021.01.010
M3 - Article
C2 - 33453367
AN - SCOPUS:85101411722
SN - 0894-7317
VL - 34
SP - 604
EP - 613
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 6
ER -