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. 2023 Oct 17;12(20):e030747.
doi: 10.1161/JAHA.123.030747. Epub 2023 Oct 10.

One-Year Outcomes and Their Relationship to Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair With MitraClip Device: Insights From the OCEAN-Mitral Registry

Shunsuke Kubo  1 , Masanori Yamamoto  2   3   4 , Mike Saji  5   6 , Masahiko Asami  7 , Yusuke Enta  8 , Masaki Nakashima  8 , Shinichi Shirai  9 , Masaki Izumo  10 , Shingo Mizuno  11 , Yusuke Watanabe  12 , Makoto Amaki  13 , Kazuhisa Kodama  14 , Junichi Yamaguchi  15 , Yoshifumi Nakajima  16 , Toru Naganuma  17 , Hiroki Bota  18 , Yohei Ohno  19 , Masahiro Yamawaki  20 , Hiroshi Ueno  21 , Kazuki Mizutani  22 , Yuya Adachi  2 , Toshiaki Otsuka  23 , Kentaro Hayashida  24 ; OCEAN‐Mitral Investigators
Collaborators, Affiliations

One-Year Outcomes and Their Relationship to Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair With MitraClip Device: Insights From the OCEAN-Mitral Registry

Shunsuke Kubo et al. J Am Heart Assoc. .

Abstract

Background Limited data are available about clinical outcomes and residual mitral regurgitation (MR) after transcatheter edge-to-edge repair in the large Asian-Pacific cohort. Methods and Results From the Optimized Catheter Valvular Intervention (OCEAN-Mitral) registry, a total of 2150 patients (primary cause of 34.6%) undergoing transcatheter edge-to-edge repair were analyzed and classified into 3 groups according to the residual MR severity at discharge: MR 0+/1+, 2+, and 3+/4+. The mortality and heart failure hospitalization rates at 1 year were 12.3% and 15.0%, respectively. Both MR and symptomatic improvement were sustained at 1 year with MR ≤2+ in 94.1% of patients and New York Heart Association functional class I/II in 95.0% of patients. Compared with residual MR 0+/1+ (20.4%) at discharge, both residual MR 2+ (30.2%; P < 0.001) and 3+/4+ (32.4%; P = 0.007) were associated with the higher incidence of death or heart failure hospitalization (adjusted hazard ratio [HR], 1.59; P < 0.001, and adjusted HR, 1.73; P = 0.008). New York Heart Association class III/IV at 1 year was more common in the MR 3+/4+ group (20.0%) than in the MR 0+/1+ (4.6%; P < 0.001) and MR 2+ (6.4%; P < 0.001) groups, and the proportion of New York Heart Association class I is significantly higher in the MR 1+ group (57.8%) than in the MR 2+ group (48.3%; P = 0.02). Conclusions The OCEAN-Mitral registry demonstrated favorable clinical outcomes and sustained MR reduction at 1 year in patients undergoing transcatheter edge-to-edge repair. Both residual MR 2+ and 3+/4+ after transcatheter edge-to-edge repair at discharge were associated with worse clinical outcomes compared with residual MR 0+/1+. Registration Information https://upload.umin.ac.jp. Identifier: UMIN000023653.

Keywords: edge‐to‐edge repair; mitral regurgitation; structural heart disease.

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Figures

Figure 1
Figure 1. Cumulative incidence of clinical outcomes.
HF indicates heart failure.
Figure 2
Figure 2. Serial changes in the MR severity and NYHA functional class.
Serial MR severity in 979 patients (A) and NYHA functional class in 1010 patients (B) with available baseline, 1‐month, and 1‐year data. MR indicates mitral regurgitation; and NYHA, New York Heart Association.
Figure 3
Figure 3. Cumulative incidence of death or HF hospitalization according to the residual MR severity at discharge.
Cumulative incidence of death or HF hospitalization in all patients (A), patients with primary MR (B), and patients with secondary MR (C). HF indicates heart failure; and MR, mitral regurgitation.
Figure 4
Figure 4. MR severity and NYHA functional class at 1 year according to the residual MR severity at discharge.
MR severity (A) and NYHA functional class (B) at 1 year according to the residual MR severity at discharge. MR indicates mitral regurgitation; and NYHA, New York Heart Association.
See this image and copyright information in PMC

Comment in

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