High body mass index is a risk factor for difficult deep sedation in percutaneous mitral valve repair

<div><p>Background</p><p>The safety and efficacy of deep sedation (DS) in MitraClip^® procedures have been shown previously. However, clinical experience demonstrates that in some patients DS is difficult to achieve. We hypothesize that some patient characteristics can predict difficult DS.</p><p>Methods</p><p>We prospectively analysed 69 patients undergoing MitraClip^® procedures using DS. Application of DS was graded as simple (group 1) or difficult (group 2) depending on a cumulative score based on one point for each of the following criteria: decrease in oxygen saturation, retention of carbon dioxide, disruptive body movements, and the need for catecholamines. Patients with one point or less were classified as group 1, and patients with two or more points were classified as group 2.</p><p>Results</p><p>In 58 of 69 patients (84.1%), the performance of DS was simple, while in 11 patients (15.9%), DS was difficult to achieve. Patients with difficult DS were characterized by a higher body mass index (33.7 ± 6.0 kg/m² vs. 26.1 ± 4.1; p = 0.001), younger age (67 ± 13 years vs. 75 ± 13 years; p = 0.044), and reduced left ventricular ejection fraction (36% ± 10 vs. 45% ± 14; p = 0.051) and presented more often with an obstructive sleep apnoea syndrome (6.9% vs. 45.5%; p = 0.003). In the multivariate analysis, body mass index was an independent predictor of difficult DS. Using a body mass index of 31 kg/m² as a cut-off value, the sensitivity of predicting difficult DS was 73%, and the specificity was 88%. Using a body mass index of 35 kg/m² as a cut-off value, the specificity increased to 97%, with a sensitivity of 36%.</p><p>Conclusion</p><p>In patients with a higher body mass index who undergo MitraClip^® procedures, DS might be difficult to perform.</p></div

Aortic Valve Calcification (AVC) was not associated with Coronary Artery Calcification (CAC).

<p>(A) AVC did not differ between patients with <i>high</i> CAC compared to patients with <i>low</i> CAC. Data are presented as minimum and maximum (crosses), interquartile range from 25 to 75% (box), mean (square), and median (line) in a box plot. (B) AVC did not correlate with CAC.</p

Angiographic characteristics of the lesion.

<p>Continuous data are presented as mean±SEM, categorical data as absolute numbers. Comparison between patients with RCA and with SVG-RCA by unpaired <i>t</i> test (continuous data) and 2-tailed Fisher’s exact test (categorical data). IVUS = intravascular ultrasound; MLA = minimal lumen cross-sectional area in the culprit segment; RCA = native right coronary artery; RLA = reference lumen area; SVG-RCA = saphenous vein graft on right coronary artery.</p><p>Angiographic characteristics of the lesion.</p

Plasma concentration of TF, and number of TF-bearing MPs in RCA and SVG-RCA before and after stent implantation.

<p>Data are presented as minimum and maximum (crosses), interquartile range from 25 to 75% (box), mean (square), and median (line) in a box plot. Comparison between arterial plasma and aspirate plasma as well as RCA and SVG-RCA was done by 2-way repeated measures ANOVA followed by Fishers LSD post-hoc test; MPs = microparticles, nr = number, RCA = native right coronary arteries, SVG-RCA = saphenous vein grafts on right coronary arteries, TF = tissue factor.</p

Characterization of patients with a complex deep sedation.

<p>Characterization of patients with a complex deep sedation.</p

Criteria for evaluation of complexity of deep sedation and classification of deep sedation according to score.

<p>Criteria for evaluation of complexity of deep sedation and classification of deep sedation according to score.</p

Procedural data and in-hospital course of patients grouped according to complexity of deep sedation.

<p>Procedural data and in-hospital course of patients grouped according to complexity of deep sedation.</p

Enhanced plasma thrombin generation and MP-induced thrombin generation in patients with high CAC.

<p>(A) In patients with high CAC compared to patients with low CAC TATc level as a marker of thrombin generation in plasma were higher. (C) TATc level correlated with CAC Score. (B) MP-induced thrombin generation was higher in patients with <i>high</i> CAC compared to patients with <i>low</i> CAC. The kinetic of thrombin generation was assessed by measuring its specific activity on the thrombin substrate at different time points (0–10 min). Data are shown as MW±SE (D) MP-induced thrombin generation correlated with CAC Score. * indicates significant difference of the mean.</p

Patients‘ characteristics.

<p>Patients‘ characteristics.</p

Multivariate logistic regression.

<p>Multivariate logistic regression.</p