Key result
Achieving MR 0/1+ after TEER linked to ~36% lower 2-year mortality versus acceptable MR 2+.
Why the study?
Post-procedural MR 0/1+ is associated with better outcomes than MR 2+, but the predictors and prognostic impact of achieving MR 0/1+ after TEER in secondary MR required evaluation.
Does an optimal procedural result (MR 0/1+) after TEER improve clinical outcomes compared to an acceptable result (MR 2+) in patients with secondary mitral regurgitation?
Observational (n=950)
Yes
Does an optimal procedural result (MR 0/1+) after TEER improve clinical outcomes compared to an acceptable result (MR 2+) in patients with secondary mitral regurgitation?
Absolute Event Rate: 25.7% vs 40%
p-value: p=< 0.001
Achieving an optimal procedural result (MR 0/1+) after TEER for secondary mitral regurgitation is associated with significantly lower mortality and heart failure hospitalizations at 2 years compared to an acceptable result (MR 2+).
Pursuing MR 0/1+ after TEER may be reasonable in secondary MR; leaves open whether it improves outcomes over MR 2+ pending randomized confirmation.
Background Procedural success after transcatheter edge‐to‐edge mitral valve repair (TEER) is defined as a reduction of mitral regurgitation (MR) degree to < moderate (2+). However, post‐procedural MR 0/1+ was found to be associated with a better outcome and a lower rate of MR recurrence compared to post‐procedural MR 2+. Aim To evaluate predictors and prognostic impact of optimal procedural result (MR 0/1+) after TEER. Methods The Italian Society of Interventional Cardiology (GIse) Registry of Transcatheter Treatment of Mitral Valve RegurgitaTiOn (GIOTTO) is a large multicenter registry including patients undergoing TEER in 19 Italian centers between January 2016 and March 2020. For the purpose of this analysis, only patients with secondary MR and successful TEER were included. Results Among 950 patients enrolled, 637 (67%) had an optimal procedural result (MR 0/1+) and 313 (33%) had an acceptable procedural result (MR 2+) after TEER. Moderate‐to‐severe, rather than severe, MR, left ventricular end‐systolic diameter <70 mm at baseline, and treatment in centers performing ≥20 procedures/year were independent predictors of the optimal procedural result. Compared to patients with acceptable procedural result, those with optimal result had shorter device time and length of stay and better outcomes with lower rates of all‐cause and cardiac deaths (25.7% vs. 40%, p < 0.001 and 16.3% vs. 24.8%, p = 0.003, respectively) and HF hospitalizations (24% vs. 30%; p = 0.035) at 2‐year follow‐up. Conclusions In patients with secondary MR undergoing TEER, an optimal procedural result is associated with favorable outcomes and can be achieved by selecting patients with moderate‐to‐severe MR, without severe left ventricular dilatation, and treated in high‐volume centers. Classifications mitral regurgitation, mitral valve repair, chronic heart failure
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Adamo et al. (2022) conducted an observational in Secondary mitral regurgitation (n=950). Optimal procedural result (MR 0/1+) after TEER vs. Acceptable procedural result (MR 2+) after TEER was evaluated on All-cause death at 2-year follow-up (p=< 0.001). An optimal procedural result (MR 0/1+) after TEER was associated with lower 2-year all-cause mortality compared to an acceptable result (MR 2+) (25.7% vs. 40%, p<0.001).
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