Predictors of optimal procedural result after transcatheter edge‐to‐edge mitral valve repair in secondary mitral regurgitation

Abstract

Background Procedural success after transcatheter edge‐to‐edge mitral valve repair (TEER) is defined as a reduction of mitral regurgitation (MR) degree to <moderate (2+). However, post‐procedural MR 0/1+ was found to be associated with a better outcome and a lower rate of MR recurrence compared to post‐procedural MR 2+. Aim To evaluate predictors and prognostic impact of optimal procedural result (MR 0/1+) after TEER. Methods The Italian Society of Interventional Cardiology (GIse) Registry of Transcatheter Treatment of Mitral Valve RegurgitaTiOn (GIOTTO) is a large multicenter registry including patients undergoing TEER in 19 Italian centers between January 2016 and March 2020. For the purpose of this analysis, only patients with secondary MR and successful TEER were included. Results Among 950 patients enrolled, 637 (67%) had an optimal procedural result (MR 0/1+) and 313 (33%) had an acceptable procedural result (MR 2+) after TEER. Moderate‐to‐severe, rather than severe, MR, left ventricular end‐systolic diameter <70 mm at baseline, and treatment in centers performing ≥20 procedures/year were independent predictors of the optimal procedural result. Compared to patients with acceptable procedural result, those with optimal result had shorter device time and length of stay and better outcomes with lower rates of all‐cause and cardiac deaths (25.7% vs. 40%, p < 0.001 and 16.3% vs. 24.8%, p = 0.003, respectively) and HF hospitalizations (24% vs. 30%; p = 0.035) at 2‐year follow‐up. Conclusions In patients with secondary MR undergoing TEER, an optimal procedural result is associated with favorable outcomes and can be achieved by selecting patients with moderate‐to‐severe MR, without severe left ventricular dilatation, and treated in high‐volume centers. Classifications mitral regurgitation, mitral valve repair, chronic heart failure

Clinical outcomes and predictors in patients with previous cardiac surgery undergoing mitral valve transcatheter edge‐to‐edge repair

“…The benefits of achieving a very low grade of rMR following MV‐TEER could be particularly evident in patients without severe LV dilation or right ventricular dysfunction 29 . Our finding is concordant with the results of the entire cohort of the GIOTTO registry, where an rMR <2+ was strongly associated with a reduction in 1‐year mortality (HR: 0.62 [95% CI: 0.46–0.84]; p = 0.002) 10,30 …”

“…29 Our finding is concordant with the results of the entire cohort of the GIOTTO registry, where an rMR <2+ was strongly associated with a reduction in 1-year mortality (HR: 0.62 [95% CI: 0.46-0.84]; p = 0.002). 10,30 According to our results, the risk of death or rehospitalization at 2 years was comparable between the two different MR etiologies (logrank: p = 0.850). On the other hand, in the entire cohort of the GIOTTO registry, patients with FMR showed significantly worse outcomes compared to those with DMR at both 1-and 2-year followups.…”

Mitral valve transcatheter edge-to-edge repair

“…In SMR, optimal MR reduction is still debated. In the COAPT trial, no outcome difference was found between patients with residual MR grade 0/1+ and 2+, while in registry studies a positive impact of lower residual MR was observed [80][81][82] . In challenging cases, MR reduction should be balanced against the increase of the transmitral gradient (>5 mmHg), which has been associated with worse outcomes 83 .…”

Evolution of tricuspid regurgitation after transcatheter edge‐to‐edge mitral valve repair for secondary mitral regurgitation and its impact on mortality

“…We also observed that a residual MR 2+ (vs. 0/1+) post‐M‐TEER was associated with an 87% reduced likelihood to have a TR ≤2+ at short‐term follow‐up. This confirms the importance to achieve optimal procedural result after M‐TEER in order to derive a prognostic benefit from the procedure 17–20 …”

“…This confirms the importance to achieve optimal procedural result after M-TEER in order to derive a prognostic benefit from the procedure. [17][18][19][20] There is only a single-centre study by Kavsur et al 10 assessing predictors of TR improvement after M-TEER by a multivariable model. This study showed that atrial fibrillation, tricuspid annulus dimensions ≥34 mm and residual MR ≥2+ were associated with a reduced probability to improve TR.…”