Outcomes After Transcatheter Edge-to-Edge Mitral Valve Repair According to Mitral Regurgitation Etiology and Cardiac Remodeling

Yoon, Sung‐Han; Makar, Moody; Kar, Saibal; Chakravarty, Tarun; Oakley, Luke; Sekhon, Navjot; Koseki, Keita; Nakamura, Mamoo; Hamilton, Michèle A.; Patel, Jignesh; Singh, Siddharth; Skaf, Sabah; Siegel, Robert J.; Bax, Jeroen J.; Makkar, Raj

doi:10.1016/j.jcin.2022.07.004

Cited by 23 publications

(16 citation statements)

References 33 publications

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“…Moreover, the recently proposed MitraScore by Raposeiras-Roubin et al [ 16 ] identified reduced LV function as an independent risk factor for all-cause mortality following TEER for MR. Finally, as was described by Yoon et al [ 17 ], patients who underwent TEER for FMR had higher rates of atrial fibrillation, lower LV ejection fraction, and larger LV dimensions, and demonstrated higher rates of both all-cause mortality and re-hospitalizations for heart failure, as compared to patients with DMR.…”

Section: Discussionmentioning

confidence: 53%

Outcomes of Transcatheter Edge-to-Edge Repair in Degenerative vs. Functional Mitral Regurgitation

Kheifets

Angelini

D’Ascenzo

et al. 2022

JCM

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Current guidelines support the use of transcatheter edge-to-edge repair (TEER) for patients with both primary and secondary mitral regurgitation. We aimed to compare the prognoses of TEER in degenerative mitral regurgitation (DMR) vs. functional mitral regurgitation (FMR). A total of 208 consecutive patients who underwent TEER over a ten-year period were analyzed. Primary endpoints included rates of all-cause death and major adverse cardiac events (MACE: composite of all-cause death, hospitalizations for heart failure, mitral valve surgery, or TEER re-intervention). A total of 148 (71%) patients were identified with FMR, while 60 (29%) were identified with DMR. Patients in the FMR group were younger (77.2 ± 8.4 vs. 80.2 ± 7.2, p = 0.02), suffered more frequently from coronary artery disease (54.1% vs. 10.0%, p = 0.02), and atrial fibrillation/flutter (70.9% vs. 38.3%, p = 0.02). Rates of 1-year death (21.6% vs. 10.0%, p = 0.03) and MACE (41.2% vs. 21.7%, p = 0.02) were higher for the FMR group, as compared to the DMR group. After correcting for variables, FMR independently predicted rates of MACE (HR-1.78, 95% CI 1.23–2.48, p = 0.04) and had a non-significant effect on one-year mortality (HR-1.67, 95%CI 0.98–3.74, p = 0.07). In our experience, worse overall 1-year composite MACE outcomes were observed after TEER in patients with FMR as compared to patients with DMR.

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Section: Discussionmentioning

confidence: 53%

Outcomes of Transcatheter Edge-to-Edge Repair in Degenerative vs. Functional Mitral Regurgitation

Kheifets

Angelini

D’Ascenzo

et al. 2022

JCM

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“…20 Similarly, most observational studies have shown TEER as an option with improved MR severity and better clinical outcomes. 16,23…”

Section: Role Of Teer In Asmrmentioning

confidence: 99%

“…20 Similarly, most observational studies have shown TEER as an option with improved MR severity and better clinical outcomes. 16,23 Though the current US valve guidelines do not comment on the role of rhythm control strategy for patients with AF and SMR, the 2020 Japanese Circulation Society valvular heart disease management guidelines give a class IIa recommendation on catheter ablation for AF in patients with persistent AF and severe symptomatic SMR, as rhythm control may reduce MR in these patients by assisting atrial and annular reverse remodeling. 24,25 7.…”

Section: Role Of Teer In Asmrmentioning

confidence: 99%

“…The incidence of significant MR in cardiogenic shock patients is 9% to 12%, and in-hospital mortality is nearly 60% when these coexist. 26–28 SMR-complicating acute myocardial infarction may occur due to mechanical complications of papillary muscle rupture or displacement of the mitral valve apparatus from the LV geometry changes due to acute remodeling, which portends a poor prognosis. 29,30 The combined occurrence of cardiogenic shock and severe MR presents the worst clinical outcomes, as most patients are at high risk for mitral valve surgery or are even inoperable.…”

Section: Teer In Cardiogenic Shock: Bridge To Surgery Destination or ...mentioning

confidence: 99%

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10 Commandments of TEER in Patients With Secondary Mitral Regurgitation

Gedela

2023

Innovations�(Phila)

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“…11,13 Likewise, many studies do not distinguish between AFMR and VFMR; therefore, clinical outcomes of TEER may be conflicting due to differences in the underlying etiology between the two entities. In recent years, observational studies investigating the efficacy of TEER in patients specifically with AFMR have displayed positive outcomes, [14][15][16] yet the relatively small number of patients in each study calls for a meta-analysis to elucidate uncertainties. Herein, we conducted a systematic review and metaanalysis of the existing literature on procedural success and clinical outcomes of TEER for AFMR, including comparison with VFMR.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of transcatheter edge‐to‐edge repair for atrial functional mitral regurgitation: A meta‐analysis of observational studies

Hamada,

Ueyama,

Aikawa

et al. 2023

Cathet Cardio Intervent

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BackgroundTranscatheter edge‐to‐edge repair (TEER) may have potential benefits in the treatment of atrial functional mitral regurgitation (AFMR), but robust evidence is currently lacking. We conducted a systematic review and meta‐analysis to investigate the clinical outcomes of TEER for AFMR, including comparisons to ventricular functional MR (VFMR).MethodsMEDLINE and EMBASE were searched through January 2023 to identify studies eligible for analysis. The primary outcome was postprocedural MR severity. Postprocedural New York Heart Association (NYHA) functional class classification and all‐cause mortality were also evaluated. Outcomes were stratified into short term (postprocedure to 6 months) and long term (6 months to 2 years).ResultsA total of eight observational studies met the inclusion criteria, enrolling 539 AFMR and 3486 VFMR patients. Postprocedural MR grade ≤2 in the AFMR group was observed in 93.7% (454/491 patients; 95% confidence interval (CI), 91.1%–96.2%, I2 = 24.3%) and 97.1% (89/93 patients; 95% CI, 92.9%–100%, I2 = 26.4%) in short‐ and long‐term follow‐up, respectively. There was no difference in the rates of postprocedural MR grade ≤2 between AFMR and VFMR either in short‐term (risk ratio [RR], 1.00 [95% CI, 0.95–1.06]; p = 0.90; I2 = 53%) or long‐term follow‐up (RR, 1.08 [95% CI, 0.89–1.32]; p = 0.44; I2 = 22%). Similarly, no difference was observed between AFMR and VFMR in the rates of postprocedural NYHA class ≤2 or all‐cause mortality.ConclusionTEER provides similar clinical outcomes for AFMR and VFMR. A high rate of MR grade ≤2 was observed in patients at both short‐ and long‐term follow‐ups. Further prospective studies with TEER versus medical therapy and/or rhythm control for AFMR are warranted.

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Outcomes After Transcatheter Edge-to-Edge Mitral Valve Repair According to Mitral Regurgitation Etiology and Cardiac Remodeling

Cited by 23 publications

References 33 publications

Outcomes of Transcatheter Edge-to-Edge Repair in Degenerative vs. Functional Mitral Regurgitation

Outcomes of Transcatheter Edge-to-Edge Repair in Degenerative vs. Functional Mitral Regurgitation

10 Commandments of TEER in Patients With Secondary Mitral Regurgitation

Outcomes of transcatheter edge‐to‐edge repair for atrial functional mitral regurgitation: A meta‐analysis of observational studies

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