Goldschmied Andreas, Sigle Manuel, Toskas Ioannis, Zdanyte Monika, Bladt Mareike, Gawaz Meinrad, Geisler Tobias
Department of Cardiology, University Hospital Tübingen, Tübingen, Germany.
Catheter Cardiovasc Interv. 2025 Jul;106(1):196-202. doi: 10.1002/ccd.31527. Epub 2025 Apr 10.
Mitral regurgitation is a common valvular dysfunction causing patient morbidity and mortality. Mitral transcatheter edge-to-edge repair (M-TEER) allows grasping of valvular leaflets and approximation via a small implant, thus reducing mitral regurgitation (MR). The implant allows staged leaflet capture and leaflet optimization before it is finally released. Real time hemodynamic monitoring could facilitate procedural success and improve patient outcomes.
Fourteen patients scheduled for elective M-TEER were included in this study. Right heart catheterization (RHC) and determination of cardiac stroke volume (SV) using the established Fick method, pulmonary capillary wedge pressure (PCWP), PCWP v-wave, left atrial (LA) pressure and LA v-wave were carried out pre and postprocedurally. Concomitantly, real time SV was measured via electrical cardiometry and acquired data were compared.
A significant increase in cardiac stroke volume measured via RHC was observed after successful M-TEER. Even though pre- and postprocedural RHC and electrical cardiometry measurements correlated significantly, electrical cardiometry was not able to reproduce the absolute increase in SV seen on RHC measurements. Furthermore, a decrease in PCWP mean pressure, PCWP v-wave, LA mean pressure and LA v-wave, were observed.
Cardiac SV increases after successful M-TEER as measured via RHC but electrical cardiometry was not able to reproduce these changes in a real time, beat-to-beat measurement.
二尖瓣反流是一种常见的瓣膜功能障碍，可导致患者发病和死亡。二尖瓣经导管缘对缘修复术（M-TEER）可通过小型植入物抓取瓣膜小叶并使其靠近，从而减少二尖瓣反流（MR）。该植入物可在最终释放前分阶段抓取小叶并优化小叶。实时血流动力学监测有助于手术成功并改善患者预后。
本研究纳入了14例计划进行择期M-TEER的患者。在手术前后进行右心导管检查（RHC），并使用既定的Fick方法测定心搏量（SV）、肺毛细血管楔压（PCWP）、PCWP v波、左心房（LA）压力和LA v波。同时，通过心电描记法测量实时SV，并对采集的数据进行比较。
成功进行M-TEER后，通过RHC测量的心搏量显著增加。尽管手术前后的RHC和心电描记法测量结果显著相关，但心电描记法无法重现RHC测量中观察到的SV绝对增加。此外，观察到PCWP平均压力、PCWP v波、LA平均压力和LA v波均降低。
通过RHC测量，成功进行M-TEER后心脏SV增加，但心电描记法无法在实时逐搏测量中重现这些变化。
