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Comment
. 2023 Mar;25(3):411-421.
doi: 10.1002/ejhf.2770. Epub 2023 Jan 16.

Transcatheter edge-to-edge repair for secondary mitral regurgitation with third-generation devices in heart failure patients - results from the Global EXPAND Post-Market study

Mathias Orban  1   2 , Wolfgang Rottbauer  3 , Mathew Williams  4 , Paul Mahoney  5 , Ralph Stephan von Bardeleben  6 , Matthew J Price  7 , Carmelo Grasso  8 , Philipp Lurz  9 , Jose L Zamorano  10 , Federico M Asch  11 , Francesco Maisano  12 , Saibal Kar  13 , Jörg Hausleiter  1   2
Affiliations
Free article
Comment

Transcatheter edge-to-edge repair for secondary mitral regurgitation with third-generation devices in heart failure patients - results from the Global EXPAND Post-Market study

Mathias Orban et al. Eur J Heart Fail. 2023 Mar.
Free article

Abstract

Aims: Mitral valve transcatheter edge-to-edge repair is a guideline-recommended treatment option for patients with secondary mitral regurgitation (SMR). The purpose of this analysis was to report contemporary real-world outcomes in SMR patients treated with third-generation MitraClip systems.

Methods and results: EXPAND is a prospective, multicentre, international, single-arm study with 1041 patients treated for mitral regurgitation (MR) with MitraClip NTR/XTR, with 30-day and 1-year follow-up. All echocardiograms were analysed by an independent echocardiographic core lab. Study outcomes included procedural outcomes, durability of MR reduction, and major adverse events including all-cause mortality and heart failure hospitalizations (HFH). A subgroup of 413 symptomatic patients (age 74.7 ± 10.1 years, 58% male) with severe SMR were included. MR reduction to MR ≤ 1+ and MR ≤ 2+ was achieved in 93.0% and 98.5% of patients, respectively, which was sustained at 1-year follow-up. All-cause mortality was 17.7% at 1-year- follow-up, and the combined endpoint of all-cause mortality or first HFH occurred in 34% of patients. This combined endpoint was significantly less frequently observed in MR ≤ 1+ patients (Kaplan-Maier estimates: 29.7% vs. 69.6% for MR ≤ 1+ vs. MR ≥ 2 +; p < 0.0001). New York Heart Association (NYHA) functional class improved significantly from baseline (NYHA ≤ II: 17%) to 1-year follow-up (NYHA ≤ II: 78%) (p < 0.0001). While MR reduction was comparable between NTR-only vs. XTR-only treated patients, less XTR clips were required for achieving MR reduction.

Conclusions: Under real-world conditions, optimal sustained MR reduction to MR ≤ 1+ was achieved in a high percentage of patients with third-generation MitraClip, which translated into symptomatic improvement and low event rates. These results appear to be comparable with recent randomized clinical trials.

Keywords: Heart failure; MitraClip; Mitral regurgitation; Mitral valve transcatheter edge-to-edge repair; Secondary mitral regurgitation; Transcatheter mitral valve repair.

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Comment on

  • Transcatheter mitral valve replacement or repair for secondary mitral regurgitation: a propensity score-matched analysis.
    Ludwig S, Kalbacher D, Ali WB, Weimann J, Adam M, Duncan A, Webb JG, Windecker S, Orban M, Giannini C, Coisne A, Karam N, Scotti A, Sondergaard L, Adamo M, Muller DWM, Butter C, Denti P, Melica B, Regazzoli D, Garatti A, Schmidt T, Andreas M, Dahle G, Taramasso M, Nickenig G, Dumonteil N, Walther T, Flagiello M, Kempfert J, Fam N, Ruge H, Rudolph TK, Wyler von Ballmoos MC, Metra M, Redwood S, Granada JF, Tang GHL, Latib A, Lurz P, von Bardeleben RS, Modine T, Hausleiter J, Conradi L; the CHOICE-MI and the EuroSMR Investigators (see online Appendix S1). Ludwig S, et al. Eur J Heart Fail. 2023 Mar;25(3):399-410. doi: 10.1002/ejhf.2797. Epub 2023 Mar 8. Eur J Heart Fail. 2023. PMID: 36883620

References

    1. O'Gara PT, Mack MJ. Secondary mitral regurgitation. N Engl J Med. 2020;383:1458-67.
    1. Bartko PE, Heitzinger G, Pavo N, Heitzinger M, Spinka G, Prausmüller S, et al. Burden, treatment use, and outcome of secondary mitral regurgitation across the spectrum of heart failure: observational cohort study. BMJ. 2021;373:n1421.
    1. Iung B, Delgado V, Rosenhek R, Price S, Prendergast B, Wendler O, et al. Contemporary presentation and management of valvular heart disease: the EURObservational Research Programme Valvular Heart Disease II survey. Circulation. 2019;140:1156-69.
    1. Deferm S, Bertrand PB, Verbrugge FH, Verhaert D, Rega F, Thomas JD, et al. Atrial functional mitral regurgitation: JACC review topic of the week. J Am Coll Cardiol. 2019;73:2465-76.
    1. Asgar AW, Mack MJ, Stone GW. Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations. J Am Coll Cardiol. 2015;65:1231-48.