EXPANDing Horizons: Optimizing Heart Failure Management Following Transcatheter Edge-to-Edge Repair of Mitral Regurgitation

This article refers to 'Impact of heart failure hospitalizations on clinical outcomes after mitral transcatheter edge-to-edge repair: Results from the EXPAND study' by M. Kessler et al., published in this issue on pages 1495-1503.Heart failure (HF) and related hospitalizations significantly impact mortality rates and healthcare costs. 1 In this context, mitral transcatheter edge-to-edge repair (M-TEER) has been established as a minimally invasive alternative to surgery for patients with symptomatic mitral regurgitation (MR) at prohibitive surgical risk. 2 The COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) demonstrated the superiority of M-TEER in combination with medical HF therapy compared to medical HF therapy alone for secondary MR (SMR). 3n this issue of the Journal, Kessler et al. present findings from the EXPAND registry -a prospective, multicentre, international, single-arm, post-market observational study that evaluated real-world outcomes of the third-generation MitraClip (NTR/XTR) in patients with SMR and primary MR (PMR). 4,5The authors observed a significant 68% decrease in annualized HF hospitalizations (HFH) after M-TEER compared to the year before treatment. 5However, the persistence of HFH incidence even after M-TEER, particularly in SMR patients, underscores the need for continued and individualized care beyond M-TEER.The study identified critical baseline characteristics associated with a higher risk of HFH after M-TEER: left ventricular ejection fraction (LVEF) <40%, New York Heart Association functional class III/IV, tricuspid regurgitation (TR) 2+, HFH prior to M-TEER, and residual MR (2+) at discharge were independently associated with HFH after M-TEER, all of which increased the risk for HFH by at least twofold (Figure 1). 5 Implementing these readily available parameters into daily clinical practice could not only help to identify patients at increased risk for HFH, but also assist in decision-making regarding follow-up intervals.