Transcatheter mitral valve repair using the edge-to-edge strategy has become a therapeutic alternative for patients with severe primary mitral valve regurgitation (MVG) who are at high or extreme surgical risk. However, both degree of residual regurgitation and gradient after the procedure should be taken into account, as in previous studies the latter was associated with a worse outcome when greater than 4 or 5 mmHg (a phenomenon that is still under study).
The aim of this retrospective study was to evaluate the prognostic value of increased MVG in the follow-up of patients who underwent MitraClip for primary mitral regurgitation.
The primary endpoint (PEP) was a composite of overall mortality and hospitalization for heart failure (HF). The secondary endpoint (SEP) included overall mortality and a composite of overall mortality, HF hospitalizations, and mitral valve reintervention.
The study enrolled 419 patients, who were divided into quartiles according to their mean MVG as assessed through echocardiography on the day after the procedure (Q1: 1.9 mmHg; Q2: 3 mmHg; Q3: 4 mmHg; Q4: 6 mmHg). Mean patient age was 80 years old, and 40% of subjects were female. The average Society of Thoracic Surgeons (STS) score was 7.7%. The mean number of MitraClip devices used was, two with no differences among quartiles. At discharge, 97% of patients achieved a ≤ moderate reduction of mitral insufficiency.
At the 2-year follow-up, there were no significant differences among the four quartiles in terms of the PEP and the SEP. Residual mitral insufficiency moderate or higher was an independent factor associated with adverse events at follow-up.
Conclusion
Increased mean MVG at discharge is not associated with adverse events in patients with primary mitral regurgitation who underwent MitraClip implantation with good outcomes.
Dr. Andrés Rodríguez.
Member of the Editorial Board in SOLACI.org .
Original Title: Prognostic Value of Increased Mitral Valve Gradient After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation.
Reference: Sung-Han Yoon, MD et al J Am Coll Cardiol Intv 2022.
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