Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y

Effects of Mitral Valve (MV) Transcatheter Edge-to-Edge Repair (TEER) on the MV annulus

M. Paukovitsch1, D. Felbel1, M. Jandek1, M. Keßler1, W. Rottbauer1, S. Markovic1, L. Schneider1

1Klinik für Innere Medizin II, Universitätsklinikum Ulm, Ulm;

Background:  Mitral valve (MV) transcatheter edge-to-edge repair (TEER) reduces the MV annular antero-posterior diameter (APd). We studied the effects and impact of APd reduction on the mitral valve annulus and its associated clinical outcomes. Methods:  104 consecutive patients undergoing MV TEER between October 2019 and May 2021 for treatment of functional mitral regurgitation (FMR) were analyzed using data from intraprocedural transesophageal echocardiography (TEE). MV annuli were measured at end-systole before and after device implantation using a commercially available semi-automatic 4D MV assessment tool (TOMTEC, Munich).  Results:  For statistical analysis, the patient cohort was divided by the median of the relative AP-d reduction during MV-TEER (-7.4% IQR: {-3.4%} {-13.1%}). Between these two groups with a lesser and a more extensive APd reduction, the preprocedural APd (4.0±0.5 vs. 4.0±0.5; p=0.56) as well as left-ventricular (LV) ejection fraction (EF) (38.9±14.3          vs. 37.4±13.6; p=0.64) and LV end-diastolic volume (167.9±89.6ml vs. 168.0±69.8ml; p=1.0) were found to be similar. Only patients with extensive APd reduction experienced a significant reduction of 2D (-7.3±7.6% vs. +2.0±12.8%; p<0.01) and 3D (-9.3±10.1% vs. +1.6±12.5%; p<0.01) MV annular areas. A comparable increase in anterolateral-posteromedial (AL-PMd) diameters could be observed in both groups (+4.7±5.0% vs. +4.4±9.6%; p=0.87), while preprocedural AL-PMd tended to be slightly greater in the group with less APd reduction (4.1±0.4cm vs. 4.2±0.5cm, p=0.056). However, similar rates of optimal MR reduction (residual MR≤1) were detected (76.9% vs. 76.9%, p=1.0). Similarly, no difference in the rate of rehospitalization was observed between these groups (5.8% vs. 13.5%; p=0.32) within the first year after MV-TEER.  Conclusion:  Preexisting AL-PMd dilation seems to present an obstacle to AP-d reduction in functional MR. However, residual MR and rates of hospitalization were comparable between patients with a lesser and a more extensive APd reduction.

https://dgk.org/kongress_programme/ht2022/aP713.html