EuroSMR Registry: Edge-to-Edge Mitral Treatment with 5-Year Outcomes

Cardiomyopathies and left atrial enlargement can lead to secondary mitral regurgitation (SMR). This condition is associated with ventricular dysfunction, causing heart failure, hospitalization, and mortality. 

According to current guidelines, surgery remains the treatment of choice. However, mitral transcatheter edge-to-edge repair (M-TEER) is a valid option for patients who are not surgical candidates, provided they are anatomically suitable.

While the COAPT study has shown a reduction in heart failure hospitalizations and 5-year mortality, further research is needed to confirm these findings.

Edge-to-Edge Treatment in Secondary Mitral Regurgitation: Results from the EuroSMR Registry

An analysis of the EuroSMR Registry included 1628 patients with symptomatic SMR who remained symptomatic despite receiving optimal medical treatment at the maximum tolerated doses and underwent M-TEER.

Mean patient age was 74 years, and 35% of subjects were women. The average EuroSCORE was 6.9. Atrial fibrillation was present in 62% of patients, coronary artery disease in 56%, a history of myocardial revascularization surgery in 22%, diabetes in 32%, hypertension in 73%, stroke in 9%, chronic obstructive pulmonary disease (COPD) in 18%, and an estimated glomerular filtration rate (eGFR) <60 mL/min in 75%. Additionally, 85% of patients were in functional class III-IV.

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Baseline echocardiographic parameters showed an ejection fraction of 36%, a regurgitant volume of 44 mL, an effective regurgitant orifice area of 0.32 cm², a tricuspid annular plane systolic excursion (TAPSE) of 16.9 mm, an end-systolic volume of 120 mL, and an end-diastolic volume of 178 mL. Moderate or greater tricuspid regurgitation was present in 18% of patients.

After the procedure, mitral regurgitation was absent or mild in 61.8% of patients, moderate in 30.4%, moderate to severe in 5.6%, and severe in 2.2%.

Two-year and five-year survival rates were 73% and 35%, respectively. Patients meeting the COAPT study criteria had better survival rates compared to those who did not (40.5% vs. 30.1%, p < 0.001). There was an association between functional class and renal function, with better functional class in patients with better glomerular filtration (class II: 42.8%, class III: 38.2%, class IV: 21.7%; p < 0.001; eGFR >60 mL/min: 49.9%, 30-60 mL/min: 33.6%; <30 mL/min: 18.2%).

Read also: Long Term Results of the International Chimney Registry.

At 5 years, residual mitral regurgitation was mild or less in 38.6% of patients, moderate in 30.5%, and severe in 22.6%.

Independent predictors of all-cause mortality at 5 years after M-TEER included age, renal function, functional class, ejection fraction, and COAPT study eligibility criteria.

Conclusion

This multicenter registry on the long-term effectiveness of edge-to-edge mitral valve repair in a real-world setting identified key predictors of long-term survival. These findings provide valuable insight for optimizing routine patient selection for this type of intervention.

Original Title: Long-Term Outcomes After Edge-to-Edge Repair of Secondary Mitral Regurgitation 5-Year Results From the EuroSMR Registry. 

Reference: Thomas J. Stocker, et al. JACC Cardiovasc Interv. 2024;17:2543–2554.