Recurrent Mitral Regurgitation After MitraClip: Predictive Factors, Morphology, and Clinical Implication

Abstract

Background: Recurrent mitral regurgitation (MR) following MitraClip has not been thoroughly investigated. We aimed to examine the predictive factors, morphology, and long-term outcome of recurrent MR after MitraClip. Methods: We assessed data from the Heart Failure Network Rhineland registry from August 2010 to October 2018. Competing risk analyses were performed using the Fine and Gray model to assess the risk of recurrent MR. Results: Among 685 MitraClip patients with a reduction in MR to ≤2+, 61 patients developed recurrent MR within the first 12 months. Flail leaflet (hazard ratio, 3.68; P =0.002) and residual MR (MR grade 2+ versus ≤1+: hazard ratio, 2.56; P =0.03) were the predictors of recurrent MR in primary MR patients, while left atrial volume (per 10 mL increase: hazard ratio, 1.11; P <0.001) and residual MR (hazard ratio, 2.45; P =0.01) were independently associated with recurrent MR in secondary MR patients. In primary MR patients, loss of leaflet insertion or leaflet tear were the predominant morphologies with recurrent MR. In secondary MR patients, more than half of the patients with recurrent MR did not show any disorder of the clip or leaflets. Patients with recurrent MR were more likely to experience unplanned heart failure hospitalization or heart failure symptom with New York Heart Association scale III/IV (54.1% versus 37.8%; P =0.018) and undergo a repeat mitral valve intervention (9.8% versus 2.2%; P =0.005) during the follow-up. In the landmark survival analysis, patients with recurrent MR tended to have lower long-term survival (58.7% versus 83.9%; P =0.08) than patients without recurrent MR. Conclusions: Flail leaflet and residual MR were the predictors of recurrent MR in primary MR patients, while a larger left atrial volume and residual MR were associated with recurrent MR in secondary MR patients, which may be associated with long-term clinical outcomes of patients after MitraClip.

Mitral Valve Surgery for Persistent or Recurrent Mitral Regurgitation After Transcatheter Edge‐to‐Edge Repair Is Associated With Improved Survival

“… 1 , 2 , 3 Despite its high short‐term technical success, persistent and recurrent severe MR occurs in ≈5% and 6% to 15% of patients after TEER, respectively. 2 , 4 , 5 , 6 With the rising number of TEER procedures, its expanding indications, and its increasing use of TEER in complex anatomies (eg, commissural jets, calcified annuli, atrial functional MR, or small valves), concerns have been raised about the management of the growing number of patients with severe MR after TEER. 7 , 8 Several studies have shown that persistent or recurrent MR following TEER confers substantially higher morbidity and mortality.…”

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

“…As recently validated and adopted in several medical centers worldwide [ 11 , 12 , 13 ], a successful TEER procedure was defined as mild or less residual MR (1+). The co-primary endpoints were rates of all-cause death and major adverse cardiac events (MACE, which comprised: all-cause death, hospitalizations for heart failure, mitral valve surgery or TEER re-interventions) at a 12-month follow-up.…”

Recurrent Mitral Regurgitation After MitraClip: Defining Success and Predicting Outcomes

“…In patients with secondary MR, multiple recent studies have demonstrated a clear relation between higher left ventricular and LA dimensions associated with progressive annular dilation and increased risk of recurrent functional MR. 2,6 While this seems intuitive, the findings highlight the importance of optimizing patients as much as possible before and after the procedure through aggressive guideline-directed medical therapy in efforts to avoid recurrent significant MR. The importance of the LA and left ventricular dimensions in comparison to the MR severity is well documented in the literature and is postulated as one of the reasons for discordant outcomes of MitraClip in this patient population between the COAPT and MITRA-FR (Percutaneous Repair With the MitraClip Device for Severe Functional Mitral Regurgitation) trials.…”