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Multicenter Study
. 2025 May;27(5):912-921.
doi: 10.1002/ejhf.3582. Epub 2025 Jan 14.

Transcatheter edge-to-edge repair in severe mitral regurgitation following acute myocardial infarction - aetiology-based analysis

Dan Haberman  1 , Rodrigo Estévez-Loureiro  2 , Andrew Czarnecki  3 , Francesco Melillo  4 , Marianna Adamo  5 , Pedro Villablanca  6 , Doron Sudarsky  7 , Fabien Praz  8 , Leor Perl  9 , Xavier Freixa  10 , Andrea Scotti  11 , Paul Fefer  12 , Konstantinos Spargias  13 , Neil Fam  14 , Lisa Manevich  15 , Giulia Masiero  16 , Luis Nombela-Franco  17 , Isaac Pascual  18 , Gabriele Crimi  19 , Vlasis Ninios  20 , Ronen Beeri  21 , Tomas Benito-Gonzalez  22 , Dabit Arzamendi  23 , Estefanıa Fernández-Peregrina  23 , Francesco Giannini  24 , Antonio Mangieri  25 , Lion Poles  1 , Jacob George  1 , Julio Cesar Echarte Morales  2 , Berenice Caneiro-Queija  2 , Paolo Denti  4 , Davide Schiavi  4 , Azeem Latib  11 , Michael Chrissoheris  13 , Haim Danenberg  14 , Giuseppe Tarantini  16 , Danny Dvir  26 , Francesco Maisano  27 , Maurizio Taramasso  28 , Mony Shuvy  26
Affiliations
Multicenter Study

Transcatheter edge-to-edge repair in severe mitral regurgitation following acute myocardial infarction - aetiology-based analysis

Dan Haberman et al. Eur J Heart Fail. 2025 May.

Abstract

Aims: To evaluate the association between transcatheter edge-to-edge repair (TEER) and outcomes in patients with significant mitral regurgitation (MR) following acute myocardial infarction (MI), focusing on the aetiology of acute post-MI MR in high-risk surgical patients.

Methods and results: The International Registry of MitraClip in Acute Mitral Regurgitation following Acute Myocardial Infarction (IREMMI) includes 187 patients with severe MR post-MI managed with TEER. Of these, 176 were included in the analysis, 23 (13%) patients had acute papillary muscle rupture (PMR) and 153 (87%) acute secondary MR. The mean age was 70 ± 10 years and 41% were female. PMR patients had fewer cardiovascular risk factors: hypertension (52% vs. 73%, p = 0.04), diabetes (26% vs. 48%, p < 0.01) but a higher left ventricular ejection fraction (45± 15% vs.35± 10%, p < 0.01) compared secondary MR patients. PMR patients were more likely to present in cardiogenic shock (91% vs. 51%, p = 0.001), require mechanical circulatory support (74% vs. 34%, p = 0.01), and had a higher EuroSCORE II (23± 13% vs. 13± 11%, p = 0.011). The median time from MI to TEER was shorter in PMR (6 days) versus secondary MR (20 days) (p < 0.01). Procedural success was similar (87% vs. 92%, p = 0.49) with comparable MR grade reduction. However, PMR patients had significantly higher in-hospital mortality rates (adjusted odds ratio [OR] 3.05, 95% confidence interval [CI] 1.15-8.12, p = 0.02), 30-day mortality rates (unadjusted OR 3.99, 95% CI 1.42-11.26, p = 0.01) and a higher rate of conversion to surgical mitral valve replacement (22% vs. 3%, p < 0.01) (unadjusted OR 8.17, 95% CI 2.15-30.96, p < 0.001). Aetiology of MR, cardiogenic shock, and procedure timing significantly impacted in-hospital mortality. After adjusting for EuroSCORE II and cardiogenic shock, MR aetiology remained the strongest predictor (adjusted OR 6.71; 95% CI 2.06-21.86, p < 0.01).

Conclusion: Transcatheter edge-to-edge repair may be considered a salvage or bridge procedure in decompensated post-MI MR patients of both aetiologies; however, patients with PMR have a higher risk of mortality and conversion to surgery.

Keywords: Cardiogenic shock; Mitral regurgitation; Myocardial infarction; Papillary muscle rupture; Transcatheter edge‐to‐edge repair.

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