Impact of periprocedural pulmonary hypertension on outcomes after mitral valve transcatheter edge-to-edge repair

Background/Introduction There are limited data on prognostic impact of periprocedural pulmonary hypertension (PH) after Mitral valve transcatheter edge-to-edge repair (M-TEER). Purpose We investigated the prognostic impact of normalized, new-onset, and residual PH after M-TEER. Methods OCEAN-Mitral registry is an ongoing, multicenter Japanese registry which includes 3764 patients who underwent M-TEER. Patients were classified into 4 groups according to periprocedural tricuspid regurgitation pressure gradient (TRPG) by echocardiography: pre-no PH/post-no PH (no PH), pre-PH/post-no PH (normalized PH), pre-no PH/post-PH (new-onset PH), and pre-PH/post-PH (residual PH). Cut-off of TRPG>31mmHg was applied for PH. Primary endpoint was cardiovascular death or heart failure hospitalization at 2 years. Logistic regression analysis was used to identify the clinical predictors of residual and new-onset PH. Results In total, 3503 patients were divided into 4 groups: 1442 patients (41.1%) in the no PH, 767 patients (21.9%) in the normalized PH, 299 patients (8.5%) in the new-onset PH, and 995 patients (28.4%) in the residual PH group, respectively. There was a significant difference in cardiovascular death or heart failure hospitalization among the 4 groups at 2 years (17.6%, 18.0%, 27.1%, and 27.4%, respectively; P<0.01). Among 1762 patients who had pre-procedural PH, 767 patients (43.5%) experienced normalization of PH with cardiovascular death or heart failure hospitalization comparable with no PH group. In multivariable logistic regression analysis, predictors of residual PH after M-TEER were pre-procedural PH(systolic pulmonary artery pressure>50mmhg) and post-procedural mitral valve pressure gradient≧4mmhg, whereas post-procedural mitral valve regurgitation and post-procedural mitral valve pressure gradient≧4mmhg were predictors of new-onset PH. Conclusions Risk stratification based on post-M-TEER PH status can identify patients at increased cardiovascular death or heart failure hospitalization after M-TEER.