Aims:

The objective of this study was to evaluate the impact of right ventricular dysfunction (RVD) on long-term survival outcome in patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) for both, atrial secondary mitral valve regurgitation (ASMR) and HFrEF-associated secondary mitral valve regurgitation (SMR).

Methods and results:

We included a cohort of 778 patients with edge-to-edge treatment of severe SMR between 2008 and 2019 from 8 experienced European centres. RVD was defined as RV-PA-Coupling (TAPSE/PASP ratio) <0.274 mm/mmHg, derived from receiver operating characteristics analysis. Patients have been divided into two groups according to the aetiology of severe mitral regurgitation (MR) and the impact of RVD and two-year survival was analysed accordingly. Overall procedural success defined as postprocedural MR ≤ 2+ was achieved in 92.7% of the patients. Within the ASMR group, 2-year survival was 76.6% (95% CI, 68.3 to 85.9) among patients with preserved RV function and 66.0% (95% CI, 48.0 to 90.9) among patients with RVD (hazard ratio for death, 1.96; 95% CI, 0.83 to 4.59; p = 0.125 by log-rank test, Figure 1). Patients in the HFrEF group showed significantly higher mortality when RVD was present (hazard ratio for death, 2.08; 95% CI, 1.54 to 2.81; p < 0.001 by log-rank test, Figure 2).

Conclusion:

TMVR effectively reduces SMR of both etiologies:  ASMR and HFrEF-associated SMR). RVD is an important predictor for increased mortality in both ASMR and HFrEF associated patients.