Higuchi, Satoshi; Orban, Mathias; Stolz, Lukas; Karam, Nicole; Praz, Fabien; Kalbacher, Daniel; Ludwig, Sebastian; Braun, Daniel; Näbauer, Michael; Wild, Mirjam G.; Neuss, Michael; Butter, Christian; Kassar, Mohammad; Petrescu, Aniela; Pfister, Roman; Iliadis, Christos; Unterhuber, Matthias; Park, Sang-Don; Thiele, Holger; Baldus, Stephan; ... (2021). Impact of Residual Mitral Regurgitation on Survival After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation. JACC. Cardiovascular Interventions, 14(11), pp. 1243-1253. Elsevier 10.1016/j.jcin.2021.03.050
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OBJECTIVES
The aim of this study was to assess the impact of residual mitral regurgitation (resMR) on mortality with respect to left ventricular dilatation (LV-Dil) or right ventricular dysfunction (RV-Dys) in patients with secondary mitral regurgitation (SMR) who underwent mitral valve transcatheter edge-to-edge repair (TEER).
BACKGROUND
The presence of LV-Dil and RV-Dys correlates with advanced stages of heart failure in SMR patients, which may impact the outcome after TEER.
METHODS
SMR patients in a European multicenter registry were evaluated. Investigated outcomes were 2-year all-cause mortality and improvement in New York Heart Association functional class with respect to MR reduction, LV-Dil (defined as LV end-diastolic volume ≥159 ml), and RV-Dys (defined as tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure ratio of <0.274 mm/mm Hg).
RESULTS
Among 809 included patients, resMR ≤1+ was achieved in 546 (67%) patients. Overall estimated 2-year mortality rate was 32%. Post-procedural resMR was significantly associated with mortality (p = 0.031). Although the improvement in New York Heart Association functional class persisted regardless of either LV-Dil or RV-Dys, the beneficial treatment effect of resMR ≤1+ on 2-year mortality was observed only in patients without LV-Dil and RV-Dys (hazard ratio: 1.75; 95% confidence interval: 1.03 to 3.00).
CONCLUSIONS
Achieving optimal MR reduction by TEER is associated with improved survival in SMR patients, especially if the progress in heart failure is not too advanced. In SMR patients with advanced stages of heart failure, as evidenced by LV-Dil or RV-Dys, the treatment effect of TEER on symptomatic improvement is maintained, but the survival benefit appears to be reduced.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Praz, Fabien Daniel, Wild, Mirjam Gauri, Kassar, Mohammad, Windecker, Stephan |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1876-7605 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Nadia Biscozzo |
Date Deposited: |
20 Jan 2022 11:40 |
Last Modified: |
02 Mar 2023 23:35 |
Publisher DOI: |
10.1016/j.jcin.2021.03.050 |
PubMed ID: |
33992551 |
Uncontrolled Keywords: |
edge-to-edge repair left ventricular volume residual mitral regurgitation right ventricular function secondary mitral regurgitation |
BORIS DOI: |
10.48350/163203 |
URI: |
https://boris.unibe.ch/id/eprint/163203 |
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