LV unloading and RV remodeling:
LV chamber dilatation, in association with residual or uncorrected MR,
increases the pericardial constraints on the right ventricle and impairs
RV contractile performance [21]. Following surgical MV repair, a
reduction in LV volumes has been associated with an improvement in RV
function [3]. As has previously been reported, our data demonstrated
that Tendyne TMVI resulted in an abolition of MR and a significant
reduction in LV volumes [12, 13]. TMVI induced LV unloading was
maximal in the period immediately following implantation, however a
gradual re-dilatation of the left ventricle was observed in those
patients with severe pre-existing LV dysfunction (Table 5; Figures 4 and
5). We also observed a post-operative reduction in LVEF which is
consistent with what has previously been described in surgical and
transcatheter repair studies due to the unmasking of the true intrinsic
myocardial function of the volume-loaded LV through elimination of MR.
Regardless, the abolition of MR and concomitant reduction in LV volumes,
resulted in an immediate and sustained improvement in RV function as
determined invasively post-deployment by RVSWI and non-invasively by
RVFAC on echocardiography (p<0.001; Table 4 and Figure 3). The
improvement in RV function was seen both in patients with moderate
(p=0.02) and severe (p=0.02) LV dysfunction.