Monitoring of mitral‐ and tricuspid valve interventions with CardioMEMS: Insights beyond imaging

Abstract

Background

Mitral‐ and tricuspid regurgitation are associated with significant morbidity and mortality and are increasingly treated interventionally. CardioMEMS is a transcutaneously implanted pressure sensor placed in the pulmonary artery that allows invasive measurement of pulmonary artery pressure and cardiac output.

Methods

This proof‐of‐concept study aimed to observe hemodynamic changes as determined by CardioMEMS after transcatheter atrioventricular valve interventions, assess the additional value of CardioMEMS on top of echocardiography, and investigate a potential effect of CardioMEMS on outcome. Patients treated with transcatheter mitral‐ or tricuspid valve interventions (mitral: TMVR, tricuspid: TTVR) or bicaval valve implantation (bi‐CAVI) were recruited. All patients were followed for 12 months.

Results

Thirty‐six patients were included (4 with CardioMEMS, 32 controls). Patients with CardioMEMS were monitored prior to intervention and 3–12 months thereafter (one received TMVR, one bi‐CAVI, one both TMVR and TTVR, and one isolated TTVR). CardioMEMS group: In both patients with TMVR and in the patient with bi‐CAVI, mean pulmonary artery pressures decreased (all p < .001) and cardiac output increased significantly (both TMVR p < .001 and bi‐CAVI p = .006) while functional parameters, echocardiography, and NT‐proBNP were difficult to interpret, unreliable, or both. Changes after TTVR remained inconclusive.

Conclusion

Invasive monitoring using CardioMEMS provides important information after mitral‐ and tricuspid valve interventions. Such data pave the way for a deeper understanding of the prerequisites for optimal patient selection and management for catheter‐based interventions.