Afterload Mismatch After MitraClip Implantation: Intraoperative Assessment and Prognostic Implications.

AIM: To evaluate the acute hemodynamic effects after MitraClip implantation and to identify predictors of afterload mismatch and its prognostic implications. METHODS: Acute hemodynamic effects were assessed intraoperatively by right heart catheterization and by transesophageal echocardiography before and after MitraClip implantation in 62 consecutive patients with severe mitral regurgitation (MR) (functional MR, 73.8%; EuroScore 2, 7.1 +/- 4.9%; left ventricular ejection fraction [LVEF], 36 +/- 15%; New York Heart Association class III/IV, 65%). Afterload mismatch was defined as a >15% decrease in LVEF (acute LV depression) or a >15% increase in LV end-diastolic volume (acute adverse LV remodeling). Patients were followed over a period of 24 months (mean, 18 +/- 3 months) with all-cause mortality as the primary endpoint. RESULTS: Successful MitraClip implantation with residual MR 12 vs in 10% of patients with EuroScores