{"title":"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。","authors":"Ashwin Vaidyanathan, Jayakar Guruswamy, Abhishek Saluja, Marvin Eng, Trevor Szymanski","doi":"10.1177/10892532241260535","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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).</p><p><strong>Design: </strong>Prospective, observational cohort study (ClinicalTrials.gov NCT03993938).</p><p><strong>Setting: </strong>Single academic hospital in Detroit, Michigan (USA), from October 2019 to February 2021.</p><p><strong>Participants: </strong>The authors included adult patients with severe mitral regurgitation who underwent successful MitraClip placement.</p><p><strong>Measurements and main results: </strong>Of 30 patients, all components of the LAP (<i>a</i> wave, <i>v</i> wave, and mean) decreased significantly after successful MitraClip placement (<i>P</i> < .01). The median (IQR) PVI increased from 21 (11-35) to 23 (13-38) after clip placement; however, this change was not statistically significant (<i>P</i> = .275). No significant correlation between change in PVI and change in LAP was observed (<i>P</i> = .235).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":46500,"journal":{"name":"Seminars in Cardiothoracic and Vascular Anesthesia","volume":" ","pages":"147-151"},"PeriodicalIF":1.1000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Use of Pleth Variability Index as a Non-invasive, Dynamic Indicator of Left Atrial Pressure Change During MitraClip: Transcatheter Mitral Valve Repair.\",\"authors\":\"Ashwin Vaidyanathan, Jayakar Guruswamy, Abhishek Saluja, Marvin Eng, Trevor Szymanski\",\"doi\":\"10.1177/10892532241260535\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Objectives: </strong>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).</p><p><strong>Design: </strong>Prospective, observational cohort study (ClinicalTrials.gov NCT03993938).</p><p><strong>Setting: </strong>Single academic hospital in Detroit, Michigan (USA), from October 2019 to February 2021.</p><p><strong>Participants: </strong>The authors included adult patients with severe mitral regurgitation who underwent successful MitraClip placement.</p><p><strong>Measurements and main results: </strong>Of 30 patients, all components of the LAP (<i>a</i> wave, <i>v</i> wave, and mean) decreased significantly after successful MitraClip placement (<i>P</i> < .01). The median (IQR) PVI increased from 21 (11-35) to 23 (13-38) after clip placement; however, this change was not statistically significant (<i>P</i> = .275). No significant correlation between change in PVI and change in LAP was observed (<i>P</i> = .235).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":46500,\"journal\":{\"name\":\"Seminars in Cardiothoracic and Vascular Anesthesia\",\"volume\":\" \",\"pages\":\"147-151\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Seminars in Cardiothoracic and Vascular Anesthesia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/10892532241260535\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/12 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Seminars in Cardiothoracic and Vascular Anesthesia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/10892532241260535","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/12 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Use of Pleth Variability Index as a Non-invasive, Dynamic Indicator of Left Atrial Pressure Change During MitraClip: Transcatheter Mitral Valve Repair.
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.