Early eccentric residual MR after M-TEER increases all-cause mortality by 72%, and non-central clip placement triples mortality risk independent of MR severity.
Does non-central clip positioning or early eccentric residual MR increase all-cause mortality in patients undergoing M-TEER for severe MR?
Non-centrally placed clips and early eccentric MR jets are associated with significantly reduced survival after M-TEER, independent of residual MR severity.
Absolute Event Rate: 0% vs 0%
Abstract Background Residual mitral regurgitation (MR) is associated with reduced survival after transcatheter edge-to-edge mitral valve repair (M-TEER). Whether the direction of the residual MR jet depends on the clip positioning and affects the long-term clinical outcome has however been scarcely investigated. Purpose To assess the impact of eccentric residual MR at discharge on long-term mortality after M-TEER. Methods We analyzed intraprocedural and early echocardiographic data (acquired 1-2 days post-TEER) in patients with severe MR deemed non-surgical candidates and treated by M-TEER at our institution between 2012-2022. Patients with intraprocedural complications requiring emergency bailing surgery were excluded. The clip positioning was defined as central if at A2-P2 or non-central if involving any other mitral scallops. MR severity was graded using a multiparametric approach, and eccentric MR defined as a non-symmetric, wall-hugging MR jet. The primary outcome was all-cause mortality. Results 118 patients (age 75±8 years) with functional (ventricular functional in 58% and atrial functional MR in 26%) or degenerative MR (16%) were followed-up for 54 23-85 months after M-TEER. An eccentric residual MR was present in 30% of the cohort at discharge and more commonly in those with non-central, medially placed clips and in moderate and severe residual MR (p0.05, Figure 1). The prevalence of eccentric jets was equally distributed among groups of functional and degenerative MR. During follow-up, both patients with early eccentric residual MR and those with non-central clips had higher risk of all-cause death (Figures 1 and 2). In Cox regression analysis, an early eccentric MR jet was associated with 72% higher risk of death (95% CI 1.1-2.9, p0.05), and a non-central clip with 3-fold higher mortality risk (95% CI 1.6-7.2, p0.01) after adjustment for age, initial MR etiology, left ventricular end-systolic diameter, number of clips, transmitral gradients and severity of residual MR (Figure 1). Conclusions Non-centrally placed clips and early eccentric MR jets are associated with reduced survival after M-TEER independent of the severity of residual MR. Our findings shed light on the importance of preprocedural planning to avoid long-term unfavourable intraatrial hemodynamics after TEER.Figure 1. Figure 2.
Soendenaa et al. (Sat,) reported a other. Early eccentric residual MR after M-TEER increases all-cause mortality by 72%, and non-central clip placement triples mortality risk independent of MR severity.