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. 2022 Nov;15(11):1843-1851.
doi: 10.1016/j.jcmg.2022.05.009. Epub 2022 Jul 13.

Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation

Philipp Doldi  1 , Lukas Stolz  2 , Mathias Orban  1 , Nicole Karam  3 , Fabien Praz  4 , Daniel Kalbacher  5 , Edith Lubos  5 , Daniel Braun  1 , Marianna Adamo  6 , Cristina Giannini  7 , Bruno Melica  8 , Michael Näbauer  2 , Satoshi Higuchi  2 , Mirjam Wild  2 , Michael Neuss  6 , Christian Butter  9 , Mohammad Kassar  4 , Aniela Petrescu  10 , Roman Pfister  11 , Christos Iliadis  11 , Matthias Unterhuber  12 , Holger Thiele  12 , Stephan Baldus  11 , Ralph Stephan von Bardeleben  10 , Niklas Schofer  13 , Christian Hagl  14 , Anna Sonia Petronio  7 , Steffen Massberg  1 , Stephan Windecker  4 , Philipp Lurz  12 , Marco Metra  6 , Jörg Hausleiter  15
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Free article

Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation

Philipp Doldi et al. JACC Cardiovasc Imaging. 2022 Nov.
Free article

Abstract

Background: Among patients with severe functional mitral regurgitation (FMR), atrial functional mitral regurgitation (aFMR) represents an underrecognized entity. Data regarding outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) in aFMR remain scarce.

Objectives: The objective of this study was to analyze the outcome of aFMR patients undergoing M-TEER.

Methods: Using patients from the international EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry undergoing M-TEER for FMR, the authors analyzed baseline characteristics and 2-year outcomes in aFMR in comparison to non-aFMR and ventricular FMR. Additionally, the impact of right ventricular dysfunction (RVD) (defined as right ventricular to pulmonary artery uncoupling) on outcome after M-TEER was assessed.

Results: Among 1,608 FMR patients treated by M-TEER, 126 (7.8%) were categorized as aFMR. All 126 aFMR patients had preserved left ventricular function without regional wall motion abnormalities, left arterial dilatation and Carpentier leaflet motion type I. Procedural success (defined as mitral regurgitation ≤2+ at discharge) was 87.2% (P < 0.001) and New York Heart Association (NYHA) functional class significantly improved during follow-up (NYHA functional class III/IV: 86.5% at baseline to 36.6% at follow-up; P < 0.001). The estimated 2-year survival rate in aFMR patients was 70.4%. Two-year survival did not differ significantly between aFMR, non-aFMR, and ventricular FMR. Besides NYHA functional class IV, RVD was identified as a strong independent predictor for 2-year survival (HR: 2.82 [95% CI: 1.24-6.45]; P = 0.014).

Conclusions: aFMR is a frequent cause of FMR and can be effectively treated with M-TEER to improve symptoms at follow-up. Advanced heart failure symptoms and RVD were identified as important risk factors for survival in aFMR patients.

Keywords: atrial functional mitral valve regurgitation; congestive heart failure; mitral valve transcatheter edge-to-edge valve repair; right ventricular dysfunction; secondary mitral valve regurgitation.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Stolz has received travel expenses from Edwards LifeSciences. Dr Orban has received speaker honoraria from Abbott Vascular and Abbot Medical; and has received speaker fees from TOMTEC Imaging Systems. Dr Karam has received speaker honoraria from Abbott Vascular; and has received consultant fees from Abbott Medical. Dr Praz has received travel expenses from Abbott Medical and Edwards LifeSciences. Dr Kalbacher has received speaker honoraria and travel expenses from Abbott Medical; and has received speaker honoraria, travel expenses, and proctor fees from Edwards LifeSciences. Dr Lubos has received speaker honoraria and research grants from Abbott Medical. Dr Braun has received speaker honoraria from Abbott Vascular. Dr Melica has received proctor fees from Abbott Medical. Dr Näbauer has received speaker honoraria from Abbott Vascular. Dr Higuchi has received lecture fees from Medtronic Japan, Daiichi Sankyo, and Ono Pharmaceutical Company. Dr Pfister has received speaker honoraria and travel expenses from Abbott Medical. Dr Iliadis has received consultant fees and travel expenses from Abbott Medical; and has received consultant fees from Edwards LifeSciences. Dr Baldus has received speaker honoraria from Abbott Medical and Edwards LifeSciences; and has received research grants from Abbott Medical. Dr Schofer has received travel expenses from Abbott Medical and Edwards LifeSciences. Dr Windecker has received research and educational grants to the institution from Abbott, Amgen, AstraZeneca, BMS, Bayer, Biotronik, Boston Scientific, Cardinal Health, CardioValve, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Johnson & Johnson, Medicure, Medtronic, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron, Sanofi-Aventis, Sinomed, and Terumo, V-Wave; serves as unpaid advisory board member and/or unpaid member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, BMS, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Sinomed, V-Wave and Xeltis, but has not received personal payments by pharmaceutical companies or device manufacturers; and is a member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration. Dr Lurz has received speaker honoraria and consultant fees from Abbott Medical. Dr Metra has received consultant fees from Abbott Medical; and has received speaker honoraria from Edwards LifeSciences. Dr Hausleiter has received speaker honoraria from and serves as consultant for Abbott Vascular and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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