Impact of Right Ventricular to Pulmonary Artery Coupling on Survival Following Indirect Mitral Annuloplasty

Abstract

BackgroundRight ventricular‐to‐pulmonary artery (RV‐PA) coupling is an important predictor of long‐term survival following transcatheter edge‐to‐edge repair. However, its impact on survival in patients undergoing indirect mitral annuloplasty is unknown. The study aimed to assess the impact of baseline RV‐PA coupling on survival following indirect mitral annuloplasty in heart failure patients.MethodsPatients were classified according to baseline RV‐PA coupling: TAPSE (tricuspid annular plane systolic excursion)/PASP (pulmonary artery systolic pressure) > 0.55 (group 1), ≤ 0.55 ≥ 0.32 (group 2) and ≤ 0.32 (group 3). Clinical follow‐up and RV function were assessed 3 and 12 months following indirect annuloplasty.ResultsA TAPSE/PASP > 0.55 was found in 19 patients, while 47 patients showed a TAPSE/PASP ≤ 0.55 > 0.32 and 26 a TAPSE/PASP ≤ 0.32. A significant reduction in vena contracta and regurgitant volume compared to baseline was found in all groups at 3‐months and 12‐months follow‐up. One‐year mortality was significantly increased in group 3 compared to the other groups (group 1: 0.95, group 2: 0.91, group 3: 0.77; Log‐Rank test p = 0.018). In groups 2 and 3 the TAPSE/PASP significantly improved during the 12‐months follow‐up, while it remained unchanged in group 1 (group 1: baseline = 0.71 ± 0.03, 12‐months = 0.67 ± 0.01; group 2: baseline = 0.43 ± 0.06, 12‐months: 0.56 ± 0.04; group 3: baseline = 0.25 ± 0.06, 12‐months: 0.4 ± 0.03; p < 0.001).ConclusionsRV‐PA uncoupling before indirect mitral annuloplasty is associated with poor survival. However, Carillon device implantation improved right heart function and RV‐PA coupling in patients with severe RV dysfunction at baseline. Therefore, Carillon device implantation can be a valuable option for transcatheter treatment of patients with FMR and right heart failure.