Long-term follow-up of patients undergoing emergency transcatheter mitral valve repair

Abstract Background/Introduction Acute mitral regurgitation (MR) is a clinical emergency, often caused by ischemic events as a complication of Acute Coronary Syndrome (ACS). Management remains uncertain due to a lack of randomized studies. Guidelines recommend medical treatment with inotropes, mechanical support if needed, and consideration of surgery, though surgical risk is very high. Recently, transcatheter edge-to-edge mitral valve repair (TEER) has emerged as an alternative for high surgical risk patients. Purpose Analyze all-cause mortality at 12 months post-procedure. Assess hospitalization for heart failure within 12 months. Evaluate TEER safety in acute MR patients in intensive care units. Methods Observational, descriptive study including 26 patients undergoing emergency TEER at the Central University Hospital of Asturias (HUCA) between April 2016 and August 2024. Results Most patients were male (73.92%), mean age 69.92 ± 10.14 years. The most relevant baseline characteristics are summarized in Table 1. Regarding cardiac history, 26.92% had dilated cardiomyopathy, 85.71% ischemic and 14.29% idiopathic. Additionally, 61.54% of patients had a history of coronary artery disease, and 44% had experienced an ACS within the previous three months. All patients were hospitalized in an intensive care unit, and the procedure was performed within the first 72 hours after admission. All presented with high surgical risk, with a mean EUROScore II of 9.15 ± 1.80%. A total of 46% had a previous diagnosis of moderate-to-severe MR. All patients had severe MR at baseline, which was predominantly functional (92.31%). Regarding etiology, half of the cases (50%) were due to acute ischemic causes, and the remaining 50% were related to left ventricular dilation. The mean left ventricular ejection fraction (LVEF) prior to the procedure was 43.93 ± 2.46%. Procedural success (MAVARC criteria) was 88.46%; average 1.25 devices implanted per patient; 7.69% had intraprocedural detachment. Post-procedure, 88.46% had grade I residual MR, mean transmitral gradient 3.05 ± 0.30 mmHg. Mean hospital stay was 15.77 ± 14.73 days (median 9.5). In-hospital mortality was 7.69%, both in the context of cardiogenic shock similar to their pre-procedural condition. No other major complications were reported during the hospital stay. At 12 months after the procedure, overall mortality was 30.77% (including in-hospital deaths). The most frequent cause of death was cardiovascular, accounting for 75% of cases. Additionally, 15.38% of patients required at least one hospitalization for heart failure within 12 months of the procedure. Conclusions 12-month survival post-TEER exceeded 50%, with cardiovascular events as the main cause of death. Low rates of rehospitalization for heart failure were observed at 12 months. TEER appears safe for acute MR patients requiring intensive care.Table 1.Basaline characteristics Figure 1.Kaplan Meire Funcions.