Shingo Kuwata; Masaki Izumo; Tetsu Tanaka; Taishi Okuno; Yoshihiro Akashi; Masanori Yamamoto; Tetsuro Shimura; Atsushi Sugiura; Shunsuke Kubo; Mike Saji; Yuki Izumi; Yusuke Enta; Shinichi Shirai; Shingo Mizuno; Yusuke Watanabe; Makoto Amaki; Kazuhisa Kodama; Junichi Yamaguchi; Toru Naganuma; Hiroki Bota; Yohei Ohno; Masahiko Asami; Daisuke Hachinohe; Masahiro Yamawaki; Hiroshi Ueno; Gaku Nakazawa; Toshiaki Otsuka; Kentaro Hayashida; on the OCEAN-Mitral investigators

doi:10.4244/EIJ-D-26-00084

Outcomes of intraprocedural haemodynamic changes in patients undergoing mitral transcatheter edge-to-edge repair

Shingo Kuwata¹, MD; Masaki Izumo¹, MD; Tetsu Tanaka¹, MD; Taishi Okuno¹, MD; Yoshihiro J. Akashi¹, MD; Masanori Yamamoto², MD; Tetsuro Shimura³, MD; Atsushi Sugiura⁴, MD; Shunsuke Kubo⁵, MD; Mike Saji⁶^,⁷, MD; Yuki Izumi⁶, MD; Yusuke Enta⁸, MD; Shinichi Shirai⁹, MD; Shingo Mizuno¹⁰, MD; Yusuke Watanabe¹¹, MD; Makoto Amaki¹², MD; Kazuhisa Kodama¹³, MD; Junichi Yamaguchi¹⁴, MD; Toru Naganuma¹⁵, MD; Hiroki Bota¹⁶, MD; Yohei Ohno¹⁷, MD; Masahiko Asami¹⁸, MD; Daisuke Hachinohe¹⁹, MD; Masahiro Yamawaki²⁰, MD; Hiroshi Ueno²¹, MD; Gaku Nakazawa²², MD; Toshiaki Otsuka²³, MD; Kentaro Hayashida²⁴, MD; on behalf the OCEAN-Mitral investigators

Abstract

Background: While the mean left atrial pressure (mLAP) reduction during mitral transcatheter edge-to-edge repair (M-TEER) has been suggested as a potential prognostic marker, comprehensive evidence from large-scale, real-world cohorts is limited, especially with stratification by mitral regurgitation (MR) aetiology.

Aims: This study aimed to evaluate the prognostic significance of intraprocedural haemodynamic changes, particularly the mLAP reduction, during M-TEER for MR, using multicentre registry data.

Methods: From the OCEAN-Mitral registry, 2,629 patients undergoing M-TEER with intraprocedural direct mLAP measurements were included. A decrease in the mLAP was defined as follows: postprocedural mLAP–preprocedural mLAP<0. The primary outcome was the composite of all-cause mortality and heart failure (HF) rehospitalisation.

Results: Among 2,629 patients (degenerative MR [DMR]: 825 [31.4%], functional MR [FMR]: 1,804 [68.6%]), the postprocedural mLAP decreased in 1,548 patients (58.9%). In the DMR cohort, the mLAP reduction was associated with a significantly lower risk of the composite outcome (adjusted hazard ratio [HR] 0.66, 95% confidence interval [CI]: 0.45-0.96; p=0.028), while no such association was observed in the FMR cohort (adjusted HR 0.90, 95% CI: 0.75-1.08; p=0.251). Interaction analysis confirmed a significant difference in prognostic impact based on MR aetiology (p for interaction=0.006). Pulmonary vein flow patterns improved, with systolic waves becoming greater than diastolic waves across both groups; however, their combination with the mLAP reduction predicted better outcomes only in DMR patients.

Conclusions: A reduction in the mLAP during M-TEER is independently associated with improved clinical outcomes in patients with DMR but not in those with FMR. These findings underscore the importance of real-time haemodynamic assessment – especially in DMR – as a valuable procedural endpoint that may aid in optimising long-term outcomes beyond anatomical MR reduction alone.

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