Impact of Residual Mitral Regurgitation on Survival After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation |
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| Authors: | Satoshi Higuchi Mathias Orban Lukas Stolz Nicole Karam Fabien Praz Daniel Kalbacher Sebastian Ludwig Daniel Braun Michael Näbauer Mirjam G. Wild Michael Neuss Christian Butter Mohammad Kassar Aniela Petrescu Roman Pfister Christos Iliadis Matthias Unterhuber Sang-Don Park Jörg Hausleiter |
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| Affiliation: | 1. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany;2. Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany;3. Department of Cardiology, European Hospital Georges Pompidou, Paris, France;4. INSERM U970, Paris Cardiovascular Research Center, Paris, France;5. Universitätsklinik für Kardiologie, Inselspital, Bern, Switzerland;6. Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany;7. Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany;8. Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany;9. Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany;10. Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany |
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| Abstract: | ![]()
ObjectivesThe aim of this study was to assess the impact of residual mitral regurgitation (resMR) on mortality with respect to left ventricular dilatation (LV-Dil) or right ventricular dysfunction (RV-Dys) in patients with secondary mitral regurgitation (SMR) who underwent mitral valve transcatheter edge-to-edge repair (TEER).BackgroundThe presence of LV-Dil and RV-Dys correlates with advanced stages of heart failure in SMR patients, which may impact the outcome after TEER.MethodsSMR patients in a European multicenter registry were evaluated. Investigated outcomes were 2-year all-cause mortality and improvement in New York Heart Association functional class with respect to MR reduction, LV-Dil (defined as LV end-diastolic volume ≥159 ml), and RV-Dys (defined as tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure ratio of <0.274 mm/mm Hg).ResultsAmong 809 included patients, resMR ≤1+ was achieved in 546 (67%) patients. Overall estimated 2-year mortality rate was 32%. Post-procedural resMR was significantly associated with mortality (p = 0.031). Although the improvement in New York Heart Association functional class persisted regardless of either LV-Dil or RV-Dys, the beneficial treatment effect of resMR ≤1+ on 2-year mortality was observed only in patients without LV-Dil and RV-Dys (hazard ratio: 1.75; 95% confidence interval: 1.03 to 3.00).ConclusionsAchieving optimal MR reduction by TEER is associated with improved survival in SMR patients, especially if the progress in heart failure is not too advanced. In SMR patients with advanced stages of heart failure, as evidenced by LV-Dil or RV-Dys, the treatment effect of TEER on symptomatic improvement is maintained, but the survival benefit appears to be reduced. |
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| Keywords: | edge-to-edge repair left ventricular volume residual mitral regurgitation right ventricular function secondary mitral regurgitation CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" confidence interval HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" hazard ratio LV-Dil" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" left ventricular dilatation LVEDV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" left ventricular end-diastolic volume NYHA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" New York Heart Association resMR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" residual mitral regurgitation RV-Dys" },{" #name" :" keyword" ," $" :{" id" :" kwrd0150" }," $$" :[{" #name" :" text" ," _" :" right ventricular dysfunction RV-PA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0160" }," $$" :[{" #name" :" text" ," _" :" right ventricle to pulmonary artery SMR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0170" }," $$" :[{" #name" :" text" ," _" :" secondary mitral regurgitation sPAP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0180" }," $$" :[{" #name" :" text" ," _" :" systolic pulmonary artery pressure TAPSE" },{" #name" :" keyword" ," $" :{" id" :" kwrd0190" }," $$" :[{" #name" :" text" ," _" :" tricuspid annular plane systolic excursion TEER" },{" #name" :" keyword" ," $" :{" id" :" kwrd0200" }," $$" :[{" #name" :" text" ," _" :" transcatheter edge-to-edge repair |
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