September 11, 2024JACC Heart Failure17 citationsOpen Access

Evaluating Mitral TEER in the Management of Moderate Secondary Mitral Regurgitation Among Heart Failure Patients

AAAnita AsgarMontreal Heart Institute GTGilbert H.L. TangInterventional / Structural Cardiology JRJason H. RogersMIT University

Structured PICO

Does mitral transcatheter edge-to-edge repair (M-TEER) improve clinical and echocardiographic outcomes in heart failure patients with moderate secondary mitral regurgitation similarly to those with severe secondary mitral regurgitation?

Population

860 heart failure patients from the EXPANDed studies, including 335 with baseline moderate secondary mitral regurgitation (2+) and 525 with baseline severe SMR (≥3+) per echocardiographic core laboratory assessment.

Intervention

Mitral transcatheter edge-to-edge repair (M-TEER) using MitraClip (EXPAND and EXPAND G4 devices).

Comparator

Patients with baseline severe SMR (≥3+) treated with M-TEER.

Outcome

1-year outcomes including MR reduction, left ventricular reverse remodeling, NYHA functional class, quality of life (KCCQ), major adverse events, all-cause mortality, and heart failure hospitalizations.

M-TEER demonstrates favorable 1-year safety, quality of life improvements, and LV reverse remodeling in heart failure patients with moderate secondary mitral regurgitation, with outcomes comparable to those seen in severe SMR.

Abstract

BACKGROUND: Moderate secondary mitral regurgitation (SMR) represents a subgroup of heart failure (HF) patients with treatment restricted to medical therapy. Outcomes in patients with moderate SMR treated with mitral transcatheter edge-to-edge repair (M-TEER) are less well known. OBJECTIVES: The aim of this study was to assess the safety and effectiveness of M-TEER in subjects with moderate SMR using the EXPANDed studies. METHODS: One-year outcomes in subjects from the EXPANDed studies (EXPAND A Contemporary, Prospective Study Evaluating Real-world Experience of Performance and Safety for the Next Generation of MitraClip Devices and EXPAND G4 A Post-Market Study Assessment of the Safety and Performance of the MitraClip G4 System MitraClip studies) with baseline moderate SMR (2+), per echocardiographic core laboratory (ECL) assessment, were compared with subjects with baseline severe SMR (≥3+). RESULTS: There were 335 subjects with moderate SMR and 525 with severe SMR at baseline per ECL review. Baseline characteristics were similar between the 2 subgroups. After treatment with M-TEER, significant MR reduction was achieved in both groups. Significant left ventricular (LV) reverse remodeling was observed through 1 year, with a >20 mL decrease in LV end-diastolic and end-systolic volumes on average in the moderate SMR group. Significant 1-year improvements in NYHA functional class (>78% NYHA functional class I or II) and quality of life (>20 points on the Kansas City Cardiomyopathy Questionnaire-Overall Summary) were observed in subjects with moderate SMR. Similarly, low rates of major adverse events, all-cause mortality, and HF hospitalizations were observed between the 2 subgroups through 1 year. CONCLUSIONS: In the EXPANDed studies, subjects with moderate SMR treated with M-TEER had improvements similar to subjects with severe SMR in quality of life and positive LV remodeling at 1 year. Future studies are needed to evaluate if M-TEER would be beneficial for HF patients with moderate SMR.

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