The predictive value of the hemodynamic profile for survival in patients undergoing transcatheter edge-to-edge mitral valve repair

Transcatheter edge-to-edge mitral valve repair (M-TEER) represents a safe treatment modality for patients with high-grade mitral regurgitation (MR). While clinical decision-making concerning the referral of suitable candidates for M-TEER is guided primarily by clinical and echocardiographic parameters, the potential of hemodynamic parameters obtained at the time of screening in predicting treatment outcomes has not been sufficiently investigated. All patients who underwent M-TEER and who provided sufficient right heart catheterisation (RHC) data prior to M-TEER were enrolled for analysis. The investigated hemodynamic parameters were analysed descriptively and their associations with survival were estimated by univariable Cox regression analysis and Kaplan–Meier’s analysis. A total of 94 patients were analysed, of whom 92.6% (87/94) had concomitant pulmonary hypertension (PH). Analysis of the hemodynamic profile revealed that 46.8% (44/94) of patients had advanced-stage congestive heart failure with a cardiac index < 2 L/min/m2, and 68% (64/94) of patients had a cardiac power index <0.5 W/m2. According to the results of the Kaplan–Meier and Cox regression analyses, a systolic pulmonary artery pressure (sPAP) > 60 mmHg and a mean right atrial pressure (RAP) > 20 mmHg were proven to be significant predictors of long-term survival after M-TEER. Analysis of the hemodynamic profile, specifically the identified predictors, contributes to the improved identification of scenarios associated with a favourable prognosis in patients undergoing M-TEER. CI: cardiac index; CPI: cardiac power index; meanRAP: mean right atrial pressure; M-TEER: transcatheter edge-to-edge mitral valve repair; PH: pulmonary hypertension; RHC: right heart catheterisation; sPAP: systolic pulmonary artery pressure.