Outcomes after transcatheter edge-to-edge mitral valve repair according to mitral regurgitation etiology and cardiac remodeling

Yoon, S.H.; Makar, M.; Kar, S.; Chakravarty, T.; Oakley, L.; Sekhon, N.; ... ; Makkar, R.R. (2022)

Article / Letter to editor

BACKGROUND Transcatheter edge-to-edge repair (TEER) has been increasingly used for selected patients with mitral regurgitation (MR), but limited data are available regarding clinical outcomes in patients with varied etiology and mechanism of MR.OBJECTIVES The aim of this study was to evaluate the outcomes of TEER according to etiology and left ventricular (LV) and left atrial remodeling.METHODS Consecutive patients who underwent TEER between 2007 and 2020 were included in the analysis. Among patients with functional MR (FMR), those with predominant LV remodeling were classified as having ventricular FMR (v-FMR), whereas those without LV remodeling but predominant left atrial remodeling were classified as having atrial FMR (a-FMR). The primary outcome was a composite of all-cause mortality and heart failure hospitalization at 2 years and was compared among patients with degenerative MR (DMR), a-FMR, and v-FMR.RESULTS A total of 1,044 patients (11% with a-FMR, 48% with v-FMR, and 41% with DMR) with a mean Society of Thoracic Surgeons score of 8.6 +/- 7.8 underwent TEER. Patients with a-FMR had higher rates of atrial fibrillation and severe tricuspid regurgitation with larger left and right atria, whereas patients with v-FMR had lower LV ejection fractions with larger LV dimensions. Residual MR more than moderate at discharge was not significantly different among the 3 groups (5.2% vs 3.2% vs 2.6%; P = 0.37). Compared with patients with DMR, 2-year event rates of the primary outcome were significantly higher in patients with a-FMR and v-FMR (21.6% vs 31.5% vs 42.3%; log-rank P < 0.001).CONCLUSIONS Despite excellent procedural outcomes, patients with a-FMR and v-FMR had worse clinical outcomes compared with those with DMR. (c) 2022 by the American College of Cardiology Foundation.

• atrial functional mitral regurgitation
• mitral regurgitation
• percutaneous mitral valve repair
• prognosis
• transcatheter edge-to-edge repair

• All authors: Yoon, S.H.; Makar, M.; Kar, S.; Chakravarty, T.; Oakley, L.; Sekhon, N.; Koseki, K.; Nakamura, M.; Hamilton, M.; Patel, J.K.; Singh, S.; Skaf, S.; Siegel, R.J.; Bax, J.J.; Makkar, R.R.
• Date: 2022-09-12
• Journal: JACC: Cardiovascular Interventions
• Volume: 15
• Issue: 17
• Pages: 1711 - 1722
• DOI: doi:10.1016/j.jcin.2022.07.004