Impact of Residual Mitral Regurgitation on Survival After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation

Higuchi, Satoshi; Orban, Mathias; Stolz, Lukas; Karam, Nicole; Praz, Fabien; Kalbacher, Daniel; Ludwig, Sebastian; Braun, Daniel; Näbauer, Michael; Wild, Mirjam G.; Neuß, Michael; Butter, Christian; Kassar, Mohammad; Petrescu, Aniela; Pfister, Roman; Iliadis, Christos; Unterhuber, Matthias; Park, Sang‐Don; Thiele, Holger; Baldus, Stephan; Bardeleben, Stephan von; Schofer, Niklas; Maßberg, Steffen; Windecker, Stephan; Lurz, Philipp; Hausleiter, Jörg

doi:10.1016/j.jcin.2021.03.050

Cited by 49 publications

(45 citation statements)

References 33 publications

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“…Until recently, procedural success in patients undergoing TEER was considered as a reduction of MR degree to less than or equal to moderate (2+) 10,11 . However, many recent studies highlighted the importance of achieving an optimal procedural result, that is, none or mild MR (0/1+), as this was associated with a better outcome and a lower rate of severe MR recurrence compared to post‐procedural moderate MR (2+) 12–17 …”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14][15][16][17] The impact of post-procedural MR degree on midterm events was greater in patients with secondary (or functional) versus primary MR and in those with less advanced heart failure (HF). 16,17 However, predictors of the optimal procedural result after TEER remain unsettled. 16 Hence, our aim was to evaluate predictors of optimal procedural result and its prognostic impact in a large population of patients with secondary MR undergoing TEER enrolled in the Italian Society of Interventional Cardiology (GIse) registry Of Transcatheter treatment of mitral valve regurgitaTiOn (GIOTTO) registry.…”

Section: Introductionmentioning

confidence: 99%

“…The impact of post‐procedural MR degree on midterm events was greater in patients with secondary (or functional) versus primary MR and in those with less advanced heart failure (HF) 16,17 . However, predictors of the optimal procedural result after TEER remain unsettled 16 …”

Section: Introductionmentioning

confidence: 99%

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Predictors of optimal procedural result after transcatheter edge‐to‐edge mitral valve repair in secondary mitral regurgitation

Adamo

Pagnesi

Rubbio

et al. 2022

Cathet Cardio Intervent

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of optimal procedural result after transcatheter edge‐to‐edge mitral valve repair in secondary mitral regurgitation

Adamo

Pagnesi

Rubbio

et al. 2022

Cathet Cardio Intervent

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“…While previous studies have suggested that patients with multiple comorbidities often had low efficacies of treatments confirmed by randomized controlled studies or expected by cohort studies [26][27][28][29][30], the impact of beta-blockers on all-cause mortality did not seem to be attenuated in patients with COPD at a glance. However, such results might be derived from selection biases considering the reduced non-cardiac, non-affected cardiac mortality, and a lower prevalence of cachexia in COPD patients with beta-blockers.…”

Section: Discussionmentioning

confidence: 71%

Different Impact of Beta-Blockers on Long-Term Mortality in Heart Failure Patients with and without Chronic Obstructive Pulmonary Disease

Higuchi

Kohno

Kohsaka

et al. 2021

JCM

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The administration of beta-blockers is challenging and their efficacy is unclear in heart failure (HF) patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the association of beta-blockers with mortality in such patients. This multicenter observational cohort study included hospitalized HF patients with a left ventricular ejection fraction <50% and evaluated them retrospectively. COPD was diagnosed based on medical records and/or the clinical judgment of each investigator. The study endpoints were two-year all-cause, cardiac, and non-cardiac mortality. This study included 83 patients with COPD and 1760 patients without. Two-year all-cause, cardiac, and non-cardiac mortality were observed in 315 (17%), 149 (8%), and 166 (9%) patients, respectively. Beta-blockers were associated with lower all-cause mortality regardless of COPD (COPD: hazard ratio [HR] 0.39, 95% CI 0.16–0.98, p = 0.044; non-COPD: HR 0.62, 95% CI 0.46–0.83, p = 0.001). This association in HF patients with COPD persisted after multivariate analysis and inverse probability weighting and was due to lower non-cardiac mortality (HR 0.40, 95% CI 0.14–1.18. p = 0.098), not cardiac mortality (HR 0.37, 95% CI 0.07–2.01, p = 0.248). Beta-blockers were associated with lower all-cause mortality in HF patients with COPD due to lower non-cardiac mortality. This may reflect selection biases in beta-blocker prescription.

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“…This is particularly promising as residual MR following TEER has been shown to have a prognostic impact. [35][36][37] Improved MR reduction might be attributable to several unique features of the PASCAL device including a central spacer filling the regurgitant orifice area, capability of independent leaflet grasping, and the flexible nitinol construction with broader-shaped paddles aiming at reducing leaflet stress.…”

Section: Discussionmentioning

confidence: 99%

One‐year results following PASCAL‐based or MitraClip‐based mitral valve transcatheter edge‐to‐edge repair

et al. 2022

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Aims Mitral valve transcatheter edge-to-edge repair (TEER) has been established as a suitable alternative to mitral valve surgery in patients with severe mitral regurgitation (MR) and high surgical risk. The PASCAL system represents a novel device, potentially augmenting the toolkit for TEER. The aim of this study was to assess and compare short and 1 year safety and efficacy of the PASCAL and MitraClip systems for TEER. Methods and results Procedural, short, and 1 year outcomes of a 1:2 propensity-matched cohort including 41 PASCAL and 82 MitraClip cases were investigated. Matching was based on clinical, laboratory, echocardiographic, and functional characteristics. The primary endpoints assessed were procedural success [as defined by the Mitral Valve Academy Research Consortium (MVARC)], residual MR, functional class, and a composite endpoint comprising death, heart failure hospitalization, and mitral valve re-intervention. We found for the PASCAL and the matched MitraClip cohort no significant differences in MVARC defined technical (90.2% vs. 95.1%, P = 0.44), device (90.2% vs. 89.0%, P = 1.0), or procedural (87.8% vs. 80.5%, P = 0.45) success rates. Accordingly, the overall MR reduction and improvement in New York Heart Association (NYHA) class were comparable (1 year follow-up: MR ≤ 2 95% vs. 93.6%, P = 1.0; NYHA ≤ 2 57.1% vs. 66.7%, P = 0.59). The composite outcome revealed no statistically significant difference between both devices (1 year follow-up: 31.7% vs. 37.8%, P = 0.55). Interestingly, we found at both short and 1 year follow-up a significantly higher rate of patients with none or trace MR in the PASCAL-treated cohort (short follow-up: 17.9% vs. 0%, P = 0.0081; 1 year follow-up: 25% vs. 0%, P = 0.0016). Conversely, the rate of aborted device implantations due to an elevated transmitral gradient was higher in PASCAL interventions (9.8% vs. 1.2%, P = 0.04). Conclusions Transcatheter edge-to-edge repair using the PASCAL or MitraClip device results in favourable and comparable outcomes regarding safety, efficacy, and clinical improvement after 1 year.

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Impact of Residual Mitral Regurgitation on Survival After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation

Cited by 49 publications

References 33 publications

Predictors of optimal procedural result after transcatheter edge‐to‐edge mitral valve repair in secondary mitral regurgitation

Predictors of optimal procedural result after transcatheter edge‐to‐edge mitral valve repair in secondary mitral regurgitation

Different Impact of Beta-Blockers on Long-Term Mortality in Heart Failure Patients with and without Chronic Obstructive Pulmonary Disease

One‐year results following PASCAL‐based or MitraClip‐based mitral valve transcatheter edge‐to‐edge repair

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