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.

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com