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. 2022 Sep 12;15(17):1731-1740.
doi: 10.1016/j.jcin.2022.06.005. Epub 2022 Aug 22.

Transcatheter Edge-to-Edge Repair for Atrial Secondary Mitral Regurgitation

Tetsu Tanaka  1 , Atsushi Sugiura  1 , Can Öztürk  1 , Johanna Vogelhuber  1 , Noriaki Tabata  1 , Nihal Wilde  1 , Sebastian Zimmer  1 , Georg Nickenig  1 , Marcel Weber  2
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Free article

Transcatheter Edge-to-Edge Repair for Atrial Secondary Mitral Regurgitation

Tetsu Tanaka et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Atrial secondary mitral regurgitation (ASMR) is a subtype of SMR that has a poor prognosis, and thus far, evidence of the therapeutic options for the management of ASMR is limited.

Objectives: This study aimed to investigate the effectiveness of transcatheter edge-to-edge repair (TEER) for ASMR.

Methods: The study retrospectively analyzed consecutive patients who underwent MitraClip at the Heart Center Bonn. ASMR was defined as cases that met all of the following criteria: 1) normal mitral leaflets without organic disorder; 2) left ventricular ejection fraction >50%; and 3) absence of LV enlargement and segmental abnormality. The primary outcome measure was MR reduction to ≤1+, and its predictors were explored in a logistic regression analysis.

Results: Among 415 patients with SMR, 118 patients met the criteria for ASMR (mean age 80 ± 8 years, 39.8% male). The technical success rate was 94.1%, and MR reduction to ≤1+ after TEER was achieved in 94 (79.7%) patients with ASMR. The in-hospital mortality rate was 2.5%. In multivariable logistic analysis, a large left atrial volume index and low leaflet-to-annulus index were associated with a lower incidence of MR reduction to ≤1+ after TEER for ASMR. In addition, the use of a newer generation of the MitraClip systems (NTR/XTR or G4 systems) was associated with a higher incidence of MR reduction to ≤1+.

Conclusions: TEER is a safe and feasible therapeutic option for patients with ASMR. Assessments of left atrial volume index and leaflet-to-annulus index may assist with patient selection for TEER in patients with ASMR.

Keywords: MitraClip; atrial secondary mitral regurgitation; transcatheter edge-to-edge repair.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Tanaka has received financial support in part from a fellowship from the Japanese College of Cardiology. Dr Nickenig has received research funding from the Deutsche Forschungsgemeinschaft, the German Federal Ministry of Education and Research, the European Union, Abbott, AGA Medical, AstraZeneca, Bayer, Berlin Chemie, Biosensus, Biotronic, Bristol Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Edwards Lifesciences, Medtronic, Novartis, Pfizer, Sanofi, and St. Jude Medical; and has received honoraria for lectures or advisory boards from Abbott, AGA Medical, AstraZeneca, Bayer, Berlin, Cardiovalve, Berlin Chemie, Biosensus, Biotronik, Bristol Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Edwards Lifesciences, Medtronic, Novartis, Pfizer, Sanofi, and St. Jude Medical. Dr Weber has received lecture or proctoring fees from Abbott, Boehringer Ingelheim, Edwards Lifesciences, Janssen, Neochord, Pfizer, and Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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