October 23, 2024КАРДИОЛОГИЯ УЗБЕКИСТАНА14 citationsOpen Access
View Full PaperCombined Impact of Residual Mitral Regurgitation and Gradient After Mitral Valve Transcatheter Edge-to-Edge Repair
Key Result
Reduction of mitral regurgitation to ≤1+ after M-TEER (achieved in 90% of 1,723 patients) was associated with lower 1-year all-cause mortality and heart failure hospitalization regardless of MVG.
Study Design
Type
Cohort (n=1,723)
Multicenter
Yes
Structured PICO
Does achieving MR ≤1+ at the cost of elevated MVG (≥5 mm Hg) after M-TEER improve 1-year clinical outcomes compared to residual MR ≥2+?
P
Population
1,723 subjects who underwent mitral transcatheter edge-to-edge repair (M-TEER) with third- and fourth-generation MitraClip systems and had evaluable echocardiograms at 30 days (pooled from EXPAND and EXPAND G4 studies).
I
Intervention
Mitral transcatheter edge-to-edge repair (M-TEER) achieving MR ≤1+ at 30 days (with or without MVG ≥5 mm Hg).
C
Comparator
M-TEER resulting in MR ≥2+ at 30 days (with or without MVG ≥5 mm Hg).
O
Outcome
1-year rates of all-cause mortality and heart failure hospitalization.hard clinical
Achieving mild or less mitral regurgitation after M-TEER provides clinical benefit at 1 year, even if it results in an elevated mitral valve gradient (≥5 mm Hg).
Abstract
BACKGROUND: Reducing mitral regurgitation (MR) during mitral transcatheter edge-to-edge repair (M-TEER) may come at the cost of increased mitral valve gradient (MVG). The combined impact of residual MR and MVG on clinical outcomes after M-TEER is unknown. OBJECTIVES: This study sought to evaluate the impact of postprocedure MR and MVG on clinical outcomes after M-TEER. METHODS: EXPANDed is a pooled, patient-level cohort of the EXPAND (A Contemporary, Prospective Study Evaluating Real-world Experience of Performance and Safety for the Next Generation of MitraClip Devices) and EXPAND G4 studies, which were designed to evaluate real-world safety and effectiveness of the third- and fourth-generation MitraClip TEER Systems. Subjects were categorized by echocardiographic core laboratory (ECL) assessments into 4 groups according to 30-day MR grade and mean MVG: 1) MR ≤1+/MVG <5 mm Hg; 2) MR ≤1+/MVG ≥5 mm Hg; 3) MR ≥2+/MVG <5 mm Hg; and 4) MR ≥2+/MVG ≥5 mm Hg. RESULTS: A total of 1,723 subjects had evaluable echocardiograms at 30 days: 72% had MR ≤1+/MVG <5 mm Hg, 18% had MR ≤1+/MVG ≥5 mm Hg, 7% had MR ≥2+/MVG <5 mm Hg, and 3% had MR ≥2+/MVG ≥5 mm Hg. MR≤1+ was sustained through 1 year in 93% of patients who achieved 30-day MR≤1+. MVG decreased from 30 days to 1 year in subjects with MVG ≥5 mm Hg (6.7 ± 4.0 to 5.5 ± 2.5 mm Hg MR ≤1+/MVG ≥5 mm Hg and 6.5 ± 1.5 to 5.5 ± 1.7 mm Hg MR ≥2+/MVG ≥5 mm Hg). One-year rates of all-cause mortality and heart failure hospitalization were lower for subjects who achieved MR ≤1+ at 30 days, regardless of MVG. CONCLUSIONS: Reduction of MR to mild or less after M-TEER with the latest-generation MitraClip systems was associated with clinical benefit regardless of MVG.