Early changes in pulmonary arterial systolic pressure after transcatheter edge-to-edge mitral valve repair and their association with outcomes

INTRODUCTION AND OBJECTIVES Transcatheter edge-to-edge repair (TEER) is a treatment for high-surgical-risk patients with severe mitral regurgitation. While pulmonary hypertension (PH) predicts poor outcomes after mitral surgery, its impact after TEER remains uncertain. The aim of this study was to assess early changes in systolic pulmonary arterial pressure (sPAP) after TEER and their association with outcomes. METHODS This multicenter, retrospective cohort study included 378 patients undergoing TEER between 2012 and 2023. sPAP was measured by transthoracic echocardiography before the procedure and on day 1. PH was defined as sPAP > 50 mmHg pre-TEER and > 40 mmHg post-TEER. Patients were classified into 4 groups: no PH (no PH before or after TEER), new PH (normal baseline sPAP with postprocedural PH), normalized PH (baseline PH with normalization after TEER), and persistent PH (PH before and after TEER). The primary endpoint was a composite of all-cause mortality, heart failure hospitalization, or mitral valve reintervention at 2 years. RESULTS Median age was 80 [interquartile range, 74-85] years, and 43% were women; 39% had baseline PH. Post-TEER, 24% developed new PH and 27% had persistent PH, resulting in residual PH in 51% of patients. Predictors of residual PH included age (aOR, 1.03/y), chronic lung disease (aOR, 2.20), baseline sPAP > 50 mmHg (aOR, 3.44), and higher postprocedural transmitral gradient (aOR, 1.18/ mmHg), while primary mitral regurgitation was protective (aOR, 0.48). Unlike baseline PH, residual PH was independently associated with the primary endpoint (aHR, 2.26). CONCLUSIONS Residual PH is common after TEER and is independently associated with adverse outcomes. Early postprocedural sPAP assessment may refine risk prognostication.