Low-risk MitraScore patients had significantly lower all-cause (48.6% vs 83.9%) and cardiovascular mortality (28.9% vs 42.1%) over a median 3.3 years after mitral transcatheter edge-to-edge repair.
What are the long-term mortality trends, causes of death, and predictors of survival in high-risk patients undergoing M-TEER for severe MR?
Long-term mortality after M-TEER is high and driven by both cardiovascular and non-cardiovascular causes, with the MitraScore effectively stratifying long-term survival risk.
Absolute Event Rate: 0% vs 0%
Abstract Background Transcatheter mitral edge-to-edge repair (M-TEER) has transformed the management of severe mitral regurgitation (MR) in high or prohibitive surgical risk patients. However, data on long-term survival and causes of death after M-TEER remain limited. Methods We analyzed a single-center registry of consecutive patients who underwent M-TEER with the MitraClip for severe MR between February 2016 and June 2020. The primary endpoint was long-term mortality trends and causes. Results Over a median follow-up of 3.3 years (IQR 1.3–5.1; max 8.5), 130 of 218 patients (59.6%) died, 55.4% from cardiovascular (CV) causes. Non-CV deaths were mainly due to sepsis (15.4%), malignancy (10.8%), trauma (3.8%), or multi-organ failure (1.5%). Among non-survivors, 29.2% had at least one non-fatal hospitalization before death. CV mortality accounted for 55% of deaths in the first year, rising to 68.4% after ≥5 years, with no significant trend over time (p=0.744). Among 88 survivors, non-fatal CV events were uncommon: 12.5% had heart failure (HF) rehospitalizations and 2.3% required repeat M-TEER; most other CV admissions were not device-related. Independent predictors of overall mortality were ischemic MR etiology, prior HF, TAPSE/sPAP ≤0.36, and ≥moderate tricuspid regurgitation, while a low MitraScore predicted better survival. Low-risk MitraScore patients had significantly lower all-cause (48.6% vs 83.9%, p0.001) and CV mortality (28.9% vs 42.1%, p=0.005) than high-risk patients. Conclusion Long-term mortality after M-TEER is influenced by both residual cardiac dysfunction and non-cardiac comorbidities. The MitraScore retains strong prognostic performance during extended follow-up.
Rubbio et al. (Sun,) reported a other. Low-risk MitraScore patients had significantly lower all-cause (48.6% vs 83.9%) and cardiovascular mortality (28.9% vs 42.1%) over a median 3.3 years after mitral transcatheter edge-to-edge repair.