BACKGROUND Patient selection for transcatheter edge-to-edge mitral valve repair (TMVR) remains challenging because of heterogenous mitral valve pathology and highly variable anatomy. The aim of this study was to investigate whether quantitative three-dimensional (3D) transesophageal echocardiographic modeling parameters are associated with optimal mitral regurgitation (MR) reduction in patients undergoing TMVR. METHODS Fifty-nine patients underwent 3D transesophageal echocardiography during TMVR. Volumetric data sets were retrospectively analyzed using mitral valve quantitative 3D modeling software (Mitral Valve Navigator). Optimal MR reduction was defined as less than moderate residual MR. Logistic regression was used to correlate 3D transesophageal echocardiographic quantitative data to procedural success. RESULTS Thirty-five patients had primary MR, 24 had mixed or secondary MR, and all patients had grade ≥ 3/4 MR before the procedure. Optimal MR reduction was achieved in 40 of 59 patients (68%). Univariate correlates of optimal MR reduction in patients with primary MR were lower mitral leaflet tenting volume (P = .049) and lower tenting height (P = .025); tenting height < 3 mm and tenting volume < 0.7 mL were associated with increased likelihood of optimal MR reduction (92% vs 48% [P = .01] and 81% vs 47% [P = .03], respectively). In mixed or secondary MR, annular height ≥ 5.5 mm was associated with increased likelihood of optimal MR reduction (94% vs 38%; P = .03). During follow-up, redo TMVR or surgical mitral valve replacement occurred exclusively in patients with suboptimal anatomy defined by 3D transesophageal echocardiography (10% vs 0%, P = .045). CONCLUSIONS Quantitative 3D echocardiographic data are associated with favorable response to TMVR and could help optimize patient selection.

中文翻译：

---

经导管二尖瓣修复过程中最佳二尖瓣反流减少的三维三维超声心动图。

背景技术由于异质性二尖瓣病理学和高度可变的解剖学，用于经导管边缘到边缘的二尖瓣修复（TMVR）的患者选择仍然具有挑战性。这项研究的目的是调查在进行TMVR的患者中，定量三维（3D）经食道超声心动图建模参数是否与最佳二尖瓣反流（MR）减少相关。方法59例患者在TMVR期间接受了3D经食道超声心动图检查。使用二尖瓣定量3D建模软件（二尖瓣导航器）对体积数据集进行了回顾性分析。最佳MR降低被定义为小于中等残留MR。使用Logistic回归将3D经食道超声心动图定量数据与手术成功相关联。结果35例原发性MR，24例混合或继发性MR，所有患者术前均≥3/4 MR。59例患者中有40例（68％）达到了最佳的MR降低。原发性MR患者最佳MR减少的单变量相关性是二尖瓣小叶下垂体积较低（P = .049）和下垂高度较低（P = .025）；帐篷高度<3 mm和帐篷体积<0.7 mL与最佳MR降低的可能性增加相关（分别为92％vs 48％[P = .01]和81％vs 47％[P = .03]）。在混合性或继发性MR中，环形高度≥5.5 mm与最佳MR降低的可能性增加相关（94％vs 38％； P = .03）。在跟进过程中，重做TMVR或手术二尖瓣置换术仅发生在3D经食管超声心动图定义的解剖学欠佳的患者中（10％vs 0％，P = .045）。结论定量3D超声心动图数据与对TMVR的良好反应相关，可帮助优化患者选择。