Background Risk stratification of patients with advanced heart failure (HF) undergoing transcatheter edge-to-edge repair (TEER) for severe mitral valve regurgitation (MR) is still challenging and identification of appropriate predictors of worse prognosis is crucial.

Objective To identify predictors of worse prognosis in patients with advanced HF undergoing TEER for severe MR.

Method: Consecutive patients with advanced HF (systolic left ventricular ejection fraction [LV-EF] <30%) with severe MR who underwent successful TEER (MR ≤2+ at discharge) were analyzed. Primary endpoint was a composite of HF events defined as all-cause mortality and HF rehospitalization. Kaplan-Meier method and log-rank test were used for survival analysis. A multivariable Cox proportional-hazards regression analysis was performed to identify independent risk factors for HF events.

Results: 125 patients (median age 70±9 years, 74% male, median LV-EF 23±3.1%) at high operative risk (LogEuro-SCORE 25.1±16.3%) were enrolled. During 18±13 months of follow-up 76 patients (60.8%) had a HF event (all cause death in 43.2%, HF rehospitalization in 44.8%). In Cox regression analysis systolic pulmonary artery pressure (PAPsyst.; Hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.93-0.99, p=0.027), severe tricuspid valve regurgitation (TR; HR 3.3; 95% CI 1.01-10.68; p=0.048) and the ratio of mitral regurgitant volume to left ventricular enddiastolic volume (RVol/LVEDV; HR 2.2; 95% CI 1.05-4.57; p=0.036) were independent predictors for HF events. Patients with lower RVol/LVEDV had a worse prognosis than those with higher RVol/LVEDV (79.2% vs. 45.8%; log-rank p=0.012). RVol/LVEDV showed good discrimination for HF events (area under the curve 0.76; 95% CI 0.60-0.92; p=0.008)

Conclusions: The main determinants of HF events in patients with advanced HF undergoing TEER are PAP syst., severe TR and RVol/LVEDV. Therefore, these predictors might be useful in risk stratification of TEER candidates.