Use of Pleth Variability Index as a Non-invasive, Dynamic Indicator of Left Atrial Pressure Change During MitraClip: Transcatheter Mitral Valve Repair.

IF 1.1 Q3 ANESTHESIOLOGY
Ashwin Vaidyanathan, Jayakar Guruswamy, Abhishek Saluja, Marvin Eng, Trevor Szymanski
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Abstract

Background: Transcatheter edge-to-edge repair (TEER) with MitraClip is a safe and effective alternative to surgical mitral valve repair/replacement in patients with high operative risk. Pleth Variability Index (PVI) is a non-invasive, dynamic index based on analysis of the respiratory variations in the plethysmographic waveform recorded transcutaneously by the pulse oximeter.

Objectives: The objective of the study was to evaluate if the hemodynamic effect of improved left-sided output after successful transcatheter mitral valve repair would lead to a significant change in PVI, and if it would correlate with the decrease in left atrial pressure (LAP).

Design: Prospective, observational cohort study (ClinicalTrials.gov NCT03993938).

Setting: Single academic hospital in Detroit, Michigan (USA), from October 2019 to February 2021.

Participants: The authors included adult patients with severe mitral regurgitation who underwent successful MitraClip placement.

Measurements and main results: Of 30 patients, all components of the LAP (a wave, v wave, and mean) decreased significantly after successful MitraClip placement (P < .01). The median (IQR) PVI increased from 21 (11-35) to 23 (13-38) after clip placement; however, this change was not statistically significant (P = .275). No significant correlation between change in PVI and change in LAP was observed (P = .235).

Conclusions: In patients with severe mitral regurgitation, successful MitraClip resulted in a significant reduction in LAP without a significant change in PVI. A larger sample size may provide more insight on the utility of using PVI as an indicator of LAP change in patients with mitral regurgitation.

使用 Pleth 变异指数作为 MitraClip 期间左心房压力变化的无创动态指标:经导管二尖瓣修复术。
背景:对于手术风险较高的患者,使用MitraClip进行经导管边缘到边缘修补术(TEER)是手术二尖瓣修补/置换术的一种安全有效的替代方法。脉搏血氧饱和度变异指数(Pleth Variability Index,PVI)是一种非侵入性的动态指数,基于脉搏血氧饱和度仪经皮记录的脉搏血氧饱和度波形的呼吸变化分析:该研究的目的是评估经导管二尖瓣修复术成功后左心室输出量的改善是否会导致 PVI 发生显著变化,以及是否与左心房压(LAP)的降低相关:前瞻性观察队列研究(ClinicalTrials.gov NCT03993938):美国密歇根州底特律市的一家学术医院,时间为 2019 年 10 月至 2021 年 2 月:作者纳入了成功接受 MitraClip 置入术的严重二尖瓣反流成年患者:在 30 名患者中,成功置入 MitraClip 后 LAP 的所有成分(a 波、v 波和平均值)均显著下降(P < .01)。夹片置入后,PVI 的中位数(IQR)从 21(11-35)升至 23(13-38);但这一变化无统计学意义(P = .275)。PVI的变化与LAP的变化之间无明显相关性(P = .235):结论:在严重二尖瓣反流患者中,成功的 MitraClip 可显著降低 LAP,而 PVI 无明显变化。更大的样本量可能会让人更深入地了解将 PVI 作为二尖瓣反流患者 LAP 变化指标的实用性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.60
自引率
14.30%
发文量
31
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