Left atrial enlargement with or without atrial fibrillation (AF), absence of valvular degeneration, and heart failure with preserved function have recently been identified as functional atrial mitral regurgitation (MR). This subtype of secondary MR currently appears to be underdiagnosed, and the need for treatment in the general population might be greater than predicted.
The aim of this multicenter study was to analyze the 30-day and 2-year clinical and echocardiographic outcomes of patients who underwent transcatheter mitral valve repair.
Inclusion criteria were functional mitral insufficiency 3+/4+, LV diastolic diameter <55 without motility disorders; persistent, permanent, or paroxysmal AF, and normal valvular structure.
Of the 1135 patients, 87 met the inclusion criteria. Mean patient age was 81 years old, and most subjects were female (61%). The Society of Thoracic Surgeons (STS) score was 4%. Technical success was 97%. The in-hospital death rate was 2%, the acute renal failure rate was 8%, and the major bleeding rate was 4.5%. At 30 days, the total mortality rate was 5% and the rate for cardiovascular death was 4%.
Mild or moderate MR was present in 98% of patients, and symptomatic improvement was observed in 79% of patients with functional class I/II within the first year of follow-up.
Echocardiographic analysis of the left atrium showed significant positive remodeling compared with baseline values and control outcomes within the first year.
The rate for cardiovascular survival and hospitalization for heart failure in these patients was 55% at 2 years. A multivariate analysis showed that postprocedural MI ≥2+ and intercommissural annular diameter ≥35 mm were independent negative predictors.
In patients with functional atrial MR, transcatheter edge-to-edge repair of the mitral valve was shown to be safe and effective, inducing positive reverse remodeling of the left atrium and mitral annulus, improving symptoms.
Dr. Andrés Rodríguez
Member of the Editorial Board of SOLACI.org.
Original Title: MItraClip in Atrial Functional mitral regurgitation: a multi-center experience. The MITRA TUNE Registry.
Reference: Antonio Popolo Rubbio, et al. EUROPCR.
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