Impact of extra-mitral valve cardiac involvement in patients with primary mitral regurgitation undergoing transcatheter edge-to-edge repair

DOI: 10.4244/EIJ-D-23-00548

Antonio Popolo Rubbio
Antonio Popolo Rubbio1, MD; Antonio Sisinni1, MD; Alice Moroni1, MD; Marianna Adamo2, MD; Carmelo Grasso3, MD; Matteo Casenghi1, MD; Maurizio B. Tusa1, MD; Marta Barletta1, MD; Paolo Denti4, MD; Arturo Giordano5, MD; Federico De Marco6, MD; Antonio L Bartorelli7, MD; Matteo Montorfano8, MD; Cosmo Godino9, MD; Eustachio Agricola9, MD; Rodolfo Citro10,11, MD; Francesco De Felice12, MD; Annalisa Mongiardo13, MD; Ida Monteforte14, MD; Emmanuel Villa15, MD; Anna Sonia Petronio16, MD; Cristina Giannini16, MD; Gabriele Crimi17, MD; Giulia Masiero18, MD; Giuseppe Tarantini18, MD; Luca Testa1, MD, PhD; Corrado Tamburino3, MD; Francesco Bedogni1, MD; on behalf of the GIOTTO registry
1. Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; 2. Cardiac Catheterisation Laboratory and Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy; 3. Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), AOU Policlinico “G. Rodolico – S. Marco”, University of Catania, Catania, Italy; 4. Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy; 5. Invasive Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy; 6. Centro Cardiologico Monzino, IRCCS, Milan, Italy; 7. Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy; 8. School of Medicine, Vita-Salute San Raffaele University, Milan, Italy and Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; 9. Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, Vita- Salute University, San Raffaele Hospital, IRCCS, Milan, Italy; 10. University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy; 11. Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy; 12. Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy; 13. Division of Cardiology, University Magna Graecia, Catanzaro, Italy; 14. AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy; 15. Valve Center, Poliambulanza Foundation Hospital, Brescia, Italy; 16. Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; 17. Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 18. Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy

Background: In the context of primary mitral regurgitation (PMR), the selection of patients for transcatheter edge-to-edge repair (TEER) does not include a systematic assessment of PMR-associated cardiac remodelling.

Aims: We aimed to investigate the epidemiology and prognostic significance of different phenotypes of extra-mitral valve (MV) cardiac involvement in a large series of patients with PMR referred for TEER.

Methods: The study included 654 patients from the multicentre Italian GIOTTO registry, stratified into groups according to extra-mitral valve (MV) cardiac involvement. The primary endpoint was all-cause death at 2-year follow-up.

Results: Patients with no cardiac involvement (NI; n=58), left heart involvement (LHI; n=343) and right heart involvement (RHI; n=253) were analysed. Acute technical success was achieved in 98% of patients. Kaplan-Meier curve analysis revealed significantly worse survival in patients with LHI and RHI (p=0.041). On multivariate Cox regression analysis, extra-MV cardiac involvement, haemoglobin level and technical success were independent predictors of the primary endpoint occurrence.

Conclusions: Grading cardiac involvement may help refine risk stratification, since at least 1 group of extra-MV cardiac involvement represents in itself a negative predictor of midterm outcome.

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mitral regurgitationmitral valve diseasemitral valve repair
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