Transcatheter Mitral Repair for Functional Mitral Regurgitation According to Left Ventricular Function: A Real-Life Propensity-Score Matched Study

Abstract

Background: Transcatheter mitral valve repair (TMVR) could improve survival in functional mitral regurgitation (FMR), but it is necessary to consider the influence of left ventricular ejection fraction (LVEF). Therefore, we compare the outcomes after TMVR with Mitraclip® between two groups according to LVEF. Methods: In an observational registry study, we compared the outcomes in patients with FMR who underwent TMVR with and without LVEF <30%. The primary endpoint was the combined one-year all-cause mortality and unplanned hospital readmissions due to HF. The secondary end-points were New York Heart Association (NYHA) functional class and mitral regurgitation (MR) severity. Propensity-score matching was used to create two groups with the same baseline characteristics, except for baseline LVEF. Results: Among 535 FMR eligible patients, 144 patients with LVEF <30% (group 1) and 144 with LVEF >30% (group 2) had similar propensity scores and were included in the analyses. The primary study endpoint was significantlly higher in group 1 (33.3% vs. 9.4%, p = 0.002). There was a maintained improvement in secondary endpoints without significant differences among groups. Conclusion: FMR patients with LVEF <30% treated with MitraClip® had higher mortality and readmissions than patients with LVEF ≥30% treated with the same device. However, both groups improved the NYHA functional class and MR severity.

Prognostic Role of TAPSE to PASP Ratio in Patients Undergoing MitraClip Procedure

“…Altogether, identification of readily available, accurate prognostic predictors remains especially relevant in patients undergoing MitraClip implantation to avoid futility, as patients considered for this intervention often present advanced HF and a high load of comorbidities. Prior studies have recognized numerous indicators of worse outcomes in this population, including reduced bi-ventricular function, enlarged left ventricular (LV) volumes, PH, severe TR and advanced functional class, amongst others [ 3 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 31 ].…”

The evolution of technical prerequisites and local boundary conditions for optimization of mitral valve interventions—Emphasis on skills development and institutional risk performance

“…In addition, TEER may also be considered in patients with functional MR (15). However, despite its initial low-risk implantation and encouraging results ( 16), the clinical results of TEER are affected by the same limitations as surgery: residual MR, presence of TR, presence of atrial fibrillation (AF), impaired LV and RV function, pulmonary hypertension, fibrosis of the myocardium, and patient-related comorbidity (17)(18)(19)(20)(21)(22)(23)(24)(25). Large trials have resulted in conflicting evidence concerning the benefits and sustainability of clinical effects, but the general conclusion has been that careful patient selection is essential in order to offer patients a predictable clinical benefit (26)(27)(28)(29)(30).…”