Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation |
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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 (DZHK), Munich, Germany;3. Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France;4. Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland;5. Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany;6. German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany;7. Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy;8. Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy;9. Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal;10. Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany;11. Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany;12. Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany;13. Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany;14. Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany |
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| Abstract: | BackgroundAmong patients with severe functional mitral regurgitation (FMR), atrial functional mitral regurgitation (aFMR) represents an underrecognized entity. Data regarding outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) in aFMR remain scarce.ObjectivesThe objective of this study was to analyze the outcome of aFMR patients undergoing M-TEER.MethodsUsing patients from the international EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry undergoing M-TEER for FMR, the authors analyzed baseline characteristics and 2-year outcomes in aFMR in comparison to non-aFMR and ventricular FMR. Additionally, the impact of right ventricular dysfunction (RVD) (defined as right ventricular to pulmonary artery uncoupling) on outcome after M-TEER was assessed.ResultsAmong 1,608 FMR patients treated by M-TEER, 126 (7.8%) were categorized as aFMR. All 126 aFMR patients had preserved left ventricular function without regional wall motion abnormalities, left arterial dilatation and Carpentier leaflet motion type I. Procedural success (defined as mitral regurgitation ≤2+ at discharge) was 87.2% (P < 0.001) and New York Heart Association (NYHA) functional class significantly improved during follow-up (NYHA functional class III/IV: 86.5% at baseline to 36.6% at follow-up; P < 0.001). The estimated 2-year survival rate in aFMR patients was 70.4%. Two-year survival did not differ significantly between aFMR, non-aFMR, and ventricular FMR. Besides NYHA functional class IV, RVD was identified as a strong independent predictor for 2-year survival (HR: 2.82 [95% CI: 1.24-6.45]; P = 0.014).ConclusionsaFMR is a frequent cause of FMR and can be effectively treated with M-TEER to improve symptoms at follow-up. Advanced heart failure symptoms and RVD were identified as important risk factors for survival in aFMR patients. |
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| Keywords: | atrial functional mitral valve regurgitation congestive heart failure mitral valve transcatheter edge-to-edge valve repair right ventricular dysfunction secondary mitral valve regurgitation AF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" atrial fibrillation aFMR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" atrial functional mitral regurgitation FMR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" functional mitral valve regurgitation HFpEF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" heart failure with preserved ejection fraction LVEF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" left ventricular ejection fraction NYHA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" New York Heart Association RVD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" right ventricular dysfunction sPAP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" systolic pulmonary artery pressure TEER" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" transcatheter valve edge-to-edge repair vFMR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" ventricular functional mitral regurgitation |
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