Outcomes of transcatheter edge-to-edge repair for atrial functional mitral regurgitation

DOI: 10.4244/EIJ-D-23-00819

Tetsu Tanaka
Tetsu Tanaka1, MD; Atsushi Sugiura1, MD, PhD; Johanna Vogelhuber1, MD; Can Öztürk1, MD; Lukas Böhm1, MD; Nihal Wilde1, MD; Sebastian Zimmer1, MD; Georg Nickenig1, MD; Marcel Weber1, MD
1. Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Germany

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Background: Prognostic benefits of transcatheter edge-to-edge repair (TEER) remain unclear in patients with atrial functional mitral regurgitation (AFMR).

Aims: We aimed to investigate clinical outcomes of TEER for AFMR.

Methods: We retrospectively classified FMR patients undergoing TEER into AFMR or ventricular FMR (VFMR). Residual MR ≤1+ at discharge was considered as optimal MR reduction, and elevated mean mitral valve pressure gradient (MPG) was defined as MPG ≥5 mmHg at discharge. The primary outcome was a composite of all-cause mortality and hospitalization due to heart failure within one year.

Results: Of 441 FMR patients, 125 patients were considered as AFMR. Residual MR ≤1+ was associated with a lower risk of the composite outcome in both AFMR and VFMR, while MPG ≥5 mmHg was associated with a higher risk of the composite outcome in AFMR but not in VFMR. AFMR patients with residual MR ≤1+ and MPG ≥5 mmHg, as well as those with residual MR >1+, had a higher incidence of the composite outcome than those with residual MR ≤1+ and MPG <5 mmHg (50.7%, 41.8%, and 14.3%, respectively; p<0.001). This association was consistent after adjustment for clinical and echocardiographic characteristics.

Conclusions: MR reduction to ≤1+ by TEER was associated with a lower risk of clinical outcomes in patients with AFMR, while MPG ≥5 mmHg was related to a higher risk of clinical outcomes. Optimal MR reduction by TEER may have potential benefits on prognosis of patients with AFMR, although the prognostic benefit may be attenuated by elevated MPG

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mitral regurgitationmitral valve diseasemitral valve repair
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