Evolution of right ventricular function and pulmonary artery coupling after transapical transcatheter mitral valve replacement

OBJECTIVES Transcatheter mitral valve replacement (TMVR) is an emerging therapy for patients with severe mitral regurgitation (MR) who are not suitable for surgery or edge-to-edge repair. The impact of TMVR on right ventricular (RV) function, and RV–pulmonary artery (PA) coupling remains poorly understood. We aimed to investigate the prognostic significance of right heart function and RV-PA coupling in TMVR recipients. METHODS This study evaluated patients from the multicentre TENDER registry entailing transapical TMVR with the Tendyne© valve. We assessed RV systolic function, tricuspid regurgitation (TR), systolic pulmonary artery pressure (sPAP), and the TAPSE/sPAP ratio as a marker of RV–PA coupling before and one year after TMVR. RESULTS Among 195 patients, 57.4% had impaired RV–PA coupling (TAPSE/sPAP < 0.4) at baseline. One-year after TMVR, sPAP and TR severity significantly improved, while TAPSE slightly declined. The TAPSE/sPAP ratio increased modestly. Patients with preserved baseline RV–PA coupling experienced numerically lower rates of mortality and heart failure hospitalization at one year, although the differences did not reach the statistical significance. Reversal of pulmonary hypertension was associated with lower mortality or rehospitalization risk. CONCLUSIONS RV dysfunction and impaired RV–PA coupling are frequent among TMVR candidates. They may inform risk stratification and carry prognostic significance. TMVR is associated with haemodynamic improvements that could benefit RV–PA coupling. Patients with secondary MR, with baseline association of impaired coupling and severe TR, or failed reversal of pulmonary hypertension, may require closer clinical follow-up. Further studies are warranted to validate these findings.