Impact of Right Ventricular Dysfunction on Outcomes After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation.

Karam, Nicole; Stolz, Lukas; Orban, Mathias; Deseive, Simon; Praz, Fabien; Kalbacher, Daniel; Westermann, Dirk; Braun, Daniel; Näbauer, Michael; Neuss, Michael; Butter, Christian; Kassar, Mohammad; Petrescu, Aniela; Pfister, Roman; Iliadis, Christos; Unterhuber, Matthias; Park, Sang-Don; Thiele, Holger; Baldus, Stephan; Stephan von Bardeleben, Ralph; ... (2021). Impact of Right Ventricular Dysfunction on Outcomes After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation. JACC. Cardiovascular imaging, 14(4), pp. 768-778. Elsevier 10.1016/j.jcmg.2020.12.015

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This study sought to assess the impact of right ventricular dysfunction (RVD) as defined by impaired right ventricular-to-pulmonary artery (RV-PA) coupling, on survival after edge-to-edge transcatheter mitral valve repair (TMVR) for severe secondary mitral regurgitation (SMR).


Conflicting data exist regarding the benefit of TMVR in severe SMR. A possible explanation could be differences in RVD.


Using data from the EuroSMR (European Registry on Outcomes in Secondary Mitral Regurgitation) registry, this study compared the characteristics and outcomes of SMR patients undergoing TMVR, according to their RV-PA coupling, assessed by tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure (TAPSE/sPAP) ratio.


Overall, 817 patients with severe SMR and available RV-PA coupling assessment underwent TMVR in the participating centers. RVD was present in 211 patients (25.8% with a TAPSE/sPAP ratio <0.274 mm/mm Hg). Although all patients demonstrated significant improvement in their New York Heart Association (NYHA) functional class, there was a trend toward a lower rate of NYHA functional class I or II among patients with RVD (56.5% vs. 65.5%, respectively; p = 0.086) after TMVR. Survival rates at 1 and 2 years were lower among patients with RVD (70.2% vs. 84.0%, respectively; p < 0.001; and 53.4% vs. 73.1%, respectively; p < 0.001). On multivariate analysis, a reduced TAPSE/sPAP ratio was a strong predictor of mortality (odds ratio: 1.62; 95% confidence interval: 1.14 to 2.31; p = 0.007).


RVD, as shown by impairment of RV-PA coupling, is a major predictor of adverse outcome in patients undergoing TMVR for severe SMR. The often neglected functional and anatomic RV parameters should be systematically assessed when planning TMVR procedures for patients with severe SMR.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Praz, Fabien Daniel, Kassar, Mohammad, Windecker, Stephan


600 Technology > 610 Medicine & health








Nadia Biscozzo

Date Deposited:

20 Jan 2022 15:16

Last Modified:

05 Dec 2022 15:59

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

edge-to-edge repair outcome right ventricular function right ventricular-to-pulmonary artery coupling secondary mitral regurgitation tricuspid regurgitation




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