Intraprocedural 3D-vena contracta area predicts survival after transcatheter edge-to-edge repair: results from MITRA-PRO registry

Background The MITRA-PRO registry revealed residual mitral regurgitation (MR) to be an important predictor of survival following transcatheter edge-to-edge repair (TEER). Intraprocedural MR assessment using 3D-Vena Contracta Area (VCA) might be a feasible tool to guide mitral TEER procedures. The study aimed to assess the impact of residual MR assessed by 3D-VCA on 1-year mortality. Methods 823 patients with residual MR quantification using 3D-VCA in the MITRA-PRO registry, were included in this study. 1-year mortality, NYHA classification and major adverse events were assessed 1-year after mitral TEER. Results Patients with trace residual MR after mitral TEER were allocated to the 3D-VCA < 0.1 cm2 group (27.8%), while a 3D-VCA ≥ 0.1 < 0.3 cm2 (55.4%) was considered as mild and a 3D-VCA ≥ 0.3 cm2 (16.8%) as relevant residual MR. One-year mortality was significantly lower in patients with non-relevant residual MR (3D-VCA < 0.1 cm2: 10.5%; ≥ 0.1 < 0.3 cm2: 16.0%; ≥ 0.3: 24.8%, p = 0.003). An increasing 3D-VCA post mitral TEER was associated with a higher 1-year mortality. At a 3D-VCA of 0.07 cm2 mortality increased significantly (1-year mortality 3D-VCA post mitral TEER ≥ 0.07 cm2: 16.5% vs. < 0.07 cm2: 7.8%; p = 0.005) indicating a 3D-VCA of 0.07 cm2 to be a cut-off value for survival in daily practice. Conclusions Residual MR assessed by 3D-VCA after TEER is associated with 1-year mortality. Therefore, 3D-VCA is a valuable echocardiographic tool for intraprocedural MR assessment during mitral TEER and achieving a lower 3D-VCA improve patient survival. (German Clinical Trials Register: DRKS00012288).