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Observational Study
. 2024 Nov 11;17(21):2543-2554.
doi: 10.1016/j.jcin.2024.08.016.

Long-Term Outcomes After Edge-to-Edge Repair of Secondary Mitral Regurgitation: 5-Year Results From the EuroSMR Registry

Thomas J Stocker  1 , Lukas Stolz  2 , Nicole Karam  3 , Daniel Kalbacher  4 , Benedikt Koell  4 , Teresa Trenkwalder  5 , Erion Xhepa  5 , Marianna Adamo  6 , Maximilian Spieker  7 , Patrick Horn  7 , Christian Butter  8 , Ludwig T Weckbach  9 , Julia Novotny  9 , Bruno Melica  10 , Christina Giannini  11 , Ralph Stephan von Bardeleben  12 , Roman Pfister  13 , Fabien Praz  14 , Philipp Lurz  12 , Volker Rudolph  15 , Marco Metra  6 , Jörg Hausleiter  16 ; EuroSMR Investigators
Collaborators, Affiliations
Free article
Observational Study

Long-Term Outcomes After Edge-to-Edge Repair of Secondary Mitral Regurgitation: 5-Year Results From the EuroSMR Registry

Thomas J Stocker et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Mitral valve transcatheter edge-to-edge repair (M-TEER) reduces secondary mitral regurgitation (MR) in heart failure and impacts survival in selected patients as demonstrated in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. However, long-term outcome data after M-TEER under real-world conditions are lacking.

Objectives: This study sought to assess long-term efficacy and survival after M-TEER in a large real-world registry.

Methods: We analyzed patients with significant secondary MR undergoing M-TEER from the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry. Long-term MR reduction, functional outcomes, survival rate, and predictors for all-cause mortality were assessed.

Results: In this study, 1,628 patients undergoing M-TEER (mean age 73.8 years, mean EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 6.9%, 86.6% NYHA functional class ≥III) with available long-term data were included. Five-year survival was 35.0%. Long-term MR reduction (MR grade ≤2+: baseline 4.1%, discharge 92.2%, 5-year follow-up 85.5%; P < 0.001) and functional improvement (NYHA ≤II: baseline 13.4%, 5-year follow-up 60.1%; P < 0.001) was observed. The degree of residual MR was associated with 5-year survival (residual MR grade ≤1+: 38.6%; 2+: 30.5%; ≥3+: 22.6%; P < 0.001). Independent predictors for 5-year all-cause mortality post-M-TEER included age, renal function, residual MR, NYHA functional class, left ventricular ejection-fraction, and COAPT trial eligibility (P < 0.01 for all).

Conclusions: This extensive multicenter registry underscores the long-term efficacy of M-TEER in real-world clinical practice and identifies predictors for long-term survival. These findings contribute valuable insights for optimizing patient selection in routine clinical interventions.

Keywords: heart failure; long-term follow-up; mitral regurgitation; mitral valve transcatheter edge-to-edge repair.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Stocker has served as consultant for Occlutech International and received speaker honoraria from Edwards Lifesciences. Dr Stolz has received speaker honoraria from Edwards Lifesciences. Dr Weckbach has received speaker honoraria from AstraZeneca and Bayer. Dr Koell has received personal fees from Edwards Lifesciences. Dr Kalbacher has received personal fees from Abbott Medical, Edwards Lifesciences, Medtronic, and Pi-Cardia Ltd. Dr Hausleiter has received speaker honoraria from and served as a consultant for 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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