Baseline moderate/severe tricuspid regurgitation was associated with a significantly higher 30-day primary safety endpoint compared to none/mild TR (10.6% vs. 2.0%, P=0.035) after MitraClip PMVR.
Cohort (n=146)
Does baseline moderate/severe tricuspid regurgitation worsen clinical and echocardiographic outcomes in patients with functional mitral regurgitation undergoing percutaneous mitral valve repair?
In patients undergoing percutaneous mitral valve repair for functional mitral regurgitation, baseline moderate/severe tricuspid regurgitation is associated with worse 30-day safety outcomes and independently predicts death and heart failure rehospitalization at 1 year.
Absolute Event Rate: 10.6% vs 2%
p-value: p=0.035
AIM: The aim of this study was to evaluate the association of baseline tricuspid regurgitation (TR) on the outcomes after percutaneous mitral valve repair (PMVR) with the MitraClip system. METHODS AND RESULTS: Data from 146 consecutive patients with functional mitral regurgitation (MR) were obtained. Two different groups, dichotomized according to the degree of pre-procedural TR (moderate/severe, n = 47 and none/mild, n = 99), had their clinical and echocardiographic outcomes through 12-month compared. At 30-day, the primary safety endpoint was significantly higher in moderate/severe TR compared with none/mild TR (10.6 vs. 2.0%, P = 0.035). Marked reduction in MR grades observed post-procedure were maintained through 12 months. Although NYHA functional class significantly improved in both groups compared with baseline, it was impaired in moderate/severe TR compared with the none/mild TR group (NYHA > II at 30 day: 33.3 vs. 9.2%, P < 0.001; at 1 year: 38.5 vs. 12.3%, respectively, P = 0.006). Left ventricle reverse remodelling and ejection fraction improvement were revealed in both groups. The primary efficacy endpoint at 12-month determined by freedom from death, surgery for mitral valve dysfunction, or grade ≥ 3+ MR was comparable between groups, but combined death and re-hospitalization for heart failure rates were higher in the moderate/severe TR group. Multivariable Cox regression analysis demonstrated that baseline moderate/severe TR and chronic kidney disease were independent predictors of this combined endpoint. CONCLUSIONS: Although PMVR with MitraClip led to improvement in MR, TR, and NYHA functional class in patients with baseline moderate/severe TR, the primary safety endpoint at 30-day was impaired, while moderate/severe TR independently predicted death and re-hospitalization for heart failure at 12-month.
Ohno et al. (2014) conducted a cohort in Functional mitral regurgitation (n=146). Moderate/severe baseline tricuspid regurgitation vs. None/mild baseline tricuspid regurgitation was evaluated on Primary safety endpoint at 30-day (p=0.035). Baseline moderate/severe tricuspid regurgitation was associated with a significantly higher 30-day primary safety endpoint compared to none/mild TR (10.6% vs. 2.0%, P=0.035) after MitraClip PMVR.