Safety and Feasibility of Transcatheter Edge-to-Edge Repair of Mitral Regurgitation in Cardiac Amyloidosis

BACKGROUND: Cardiac amyloidosis (CA) is characterized by amyloid deposits in the heart leading to various manifestations including heart failure (HF). CA patients often present with severe mitral regurgitation (MR), complicating management in patients. Transcatheter edge-to-edge repair (TEER) offers an interventional option for patients at high surgical risk. OBJECTIVES: The objective of this study was to assess the safety, efficacy, and clinical outcomes of TEER in patients with CA and severe MR. METHODS: This retrospective study included 27 patients with CA and 81 matched patients with HF without CA and severe MR who underwent TEER. Outcome parameters included technical success, echocardiographic response, laboratory biomarkers, and clinical symptom burden. Follow-up was performed at a median of 103 days (90-144) and included clinical assessment, echocardiography, and laboratory analysis. RESULTS: Patients had a median age of 79 (75-83) years with 86.1% male and NYHA functional class ≥III in 85.1% prior to intervention. TEER was successful in 100% in both groups. Symptom burden improved in both groups (NYHA functional class I/II in 50.5% vs 57.8%, CA vs HF). MR was reduced, achieving MR ≤2+ in 100%, with a reduction in regurgitant volume in both groups (P < 0.001). No procedure-related major adverse events were reported with a 100% 30-day survival rate. Scoring for MR anatomical complexity did not show a difference. CONCLUSIONS: The study demonstrated safety and feasibility of TEER in patients with CA and severe MR, with satisfactory procedure-related outcome and absence of severe adverse events, thus highlighting the potential benefits in CA patients.