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. 2024 Feb 19;20(4):e250-e260.
doi: 10.4244/EIJ-D-23-00819.

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

Tetsu Tanaka  1 , Atsushi Sugiura  1 , Johanna Vogelhuber  1 , Can Öztürk  1 , Lukas Böhm  1 , Nihal Wilde  1 , Sebastian Zimmer  1 , Georg Nickenig  1 , Marcel Weber  1
Affiliations

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

Tetsu Tanaka et al. EuroIntervention. .

Abstract

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

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

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

Results: Of 441 FMR patients, 125 patients were considered as having AFMR. Residual MR ≤1+ was associated with a lower risk of the composite outcome in both AFMR and VFMR patients, while an MPG ≥5 mmHg was associated with a higher risk of the composite outcome in patients with AFMR but not with VFMR. AFMR patients with residual MR ≤1+ and an 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 an 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: An MR reduction to ≤1+ following TEER was associated with a lower risk of clinical outcomes in patients with AFMR, while an MPG ≥5 mmHg was related to a higher risk of clinical outcomes. Optimal MR reduction by TEER may have potential benefits on the prognosis of patients with AFMR, although the prognostic benefit may be attenuated by an elevated MPG.

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Conflict of interest statement

T. Tanaka has been financially supported in part by a Fellowship from the Japanese College of Cardiology and the Uehara Memorial Foundation; he has also received honoraria from Canon Medical Systems. A. Sugiura has received honoraria for lectures from Edwards Lifesciences. G. Nickenig has received research funding from the Deutsche Forschungsgemeinschaft, the German Federal Ministry of Education and Research, the EU, Abbott, Edwards Lifesciences, Medtronic, and St Jude Medical; he has also received honoraria for lectures or advisory boards from Abbott, Edwards Lifesciences, Medtronic, and St Jude Medical. M. Weber has received lecture or proctoring fees from Abbott and Edwards Lifesciences. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Study flowchart.
FMR: functional mitral regurgitation; MR: mitral regurgitation; MPG: mitral valve pressure gradient; TEER: transcatheter edge-to-edge repair
Figure 2
Figure 2. Association of residual MR and MPG with the composite outcome according to FMR aetiology.
Incidence of the composite outcome according to residual mitral regurgitation (MR) and mean mitral valve pressure gradient (MPG) in patients with atrial functional MR (A, B) and ventricular functional MR (C, D). FMR: functional mitral regurgitation; HF: heart failure
Figure 3
Figure 3. Spline curves for the hazard ratio of MPG in patients with AFMR and VFMR.
Spline curves for the relationship between MPG at discharge and its hazard risk are shown in patients with AFMR (A) and VFMR (B). AFMR: atrial functional mitral regurgitation; MPG: mean mitral valve pressure gradient; VFMR: ventricular functional mitral regurgitation
Figure 4
Figure 4. Association of procedural results with the composite outcome in patients with AFMR and VFMR.
Incidence of the composite outcome according to residual mitral regurgitation (MR) and mean mitral valve pressure gradient (MPG) in patients with atrial functional mitral regurgitation (AFMR) (A) and ventricular functional mitral regurgitation (VFMR) (B). HF: heart failure
Central illustration
Central illustration. Association of residual MR and MPG with clinical outcome after TEER according to functional MR aetiology.
Residual MR >1+ was associated with a higher incidence of the one-year composite outcome, consisting of all-cause mortality and hospitalisation due to heart failure, in both atrial and ventricular functional MR. In patients with atrial functional MR, residual MR ≤1+ with an MPG ≥5 mmHg also resulted in a higher risk of the composite outcome. HF: heart failure; MPG: mean mitral valve pressure gradient; MR: mitral regurgitation; TEER: transcatheter edge-to-edge repair
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