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

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.