Abstract 1174 Transcatheter Mitral Valve Repair in Patients with Atrial Functional Mitral Regurgitation

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Transcatheter Mitral Valve Repair in Patients with Atrial Functional Mitral Regurgitation
P. Doldi¹, L. Stolz¹, M. Orban¹, N. Karam¹, F. Pranz², D. Kalbacher³, E. Lubos⁴, D. Braun¹, M. Adamo⁵, B. Melica⁶, M. Näbauer¹, S. Higuchi¹, M. Wild¹, M. Neuß⁷, C. Butter⁷, M. Kassar², A. Petrescu⁸, R. Pfister⁹, C. Iliadis⁹, M. Unterhuber¹⁰, H. Thiele¹⁰, S. Baldus¹¹, R. S. von Bardeleben¹², N. Schofer³, C. Hagl¹³, A. S. Petronio¹⁴, S. Massberg¹, S. Windecker², P. Lurz¹⁰, M. Metra⁵, J. Hausleiter¹
¹Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München; ²Kardiologie, Universitätsklinikum Kardiologie Inselspital Bern, Bern, CH; ³Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; ⁴Kardiologie und Angiologie, Katholisches Marienkrankenhaus gGmbH, Hamburg; ⁵Cardiac Catheterization Laboratory and Cardiology, University of Brescia, Brescia, IT; ⁶Centro Hospitalar Vila Nova de Gaia e Espinho, Porto, PT; ⁷Herzzentrum Brandenburg / Kardiologie, Immanuel Klinikum Bernau, Bernau bei Berlin; ⁸Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz; ⁹Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln; ¹⁰Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; ¹¹Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln; ¹²Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz; ¹³Herzchirurgische Klinik und Poliklinik, LMU Klinikum der Universität München, München; ¹⁴Cardiothoracic and Vascular Department, University of Pisa, Pisa, IT;
Background Among patients with severe secondary mitral regurgitation (SMR), atrial functional MR (aFMR) represents an underrecognized entity. Data regarding outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) remain scarce. Objective The objective was to analyse the outcome of aFMR patients undergoing M-TEER. Methods and results Using patients of the international EuroSMR registry undergoing M-TEER for SMR, we analysed baseline characteristics and 2-year outcomes according the presence of aFMR. Patients were considered to have aFMR showing preserved left ventricular ejection fraction (LVEF ≥50%) without any regional wall motion abnormalities, Carpentier Type I leaflet motion and dilated left atria. Furthermore, the impact of right ventricular dysfunction (RVD) defined as RV/PA coupling (TAPSE/sPAP), on outcomes after M-TEER was assessed. A total number of 126 patients corresponding to 8% of the EuroSMR registry, 61% female, with a median age of 80 years (76 to 83yrs) were included in the analysis. The rate of atrial fibrillation was 79% and NYHA functional class III or higher was present in 86%. MR severity in aFMR patients was substantially reduced after M-TEER. Procedural success defined as MR ≤2+ at the end of the procedure was 87.2% and 62.4% showed MR ≤1+, Figure 1A. NYHA functional class significantly improved after M-TEER. The estimated overall 2-year survival rate was 70.4% (62 to 80%), Figure 1B. Univariate and multivariate cox proportional hazard models identified baseline NYHA class IV (HR 3.49, 95% CI: 1.67, 7.30, p=<0.001) and RVD (HR 2.72, 95% CI: 1.28, 5.76, p=0.009) as independent predictors for 2-year mortality in aFMR patients. Patients with RVD showed significantly impaired 2-year survival (HR: 2.82, 95% CI: 1.24 to 6.45; p=0.014, Figure 2). Conclusion M-TEER in aFMR is effective and reduces heart failure symptoms at follow-up. AFMR is not rare and an earlier treatment – before RVD develops – might be associated with better outcomes. $C:\Users\roll\Desktop\Abstract_Grafiken\2021-11-24_09h06_39.jpg$ $C:\Users\roll\Desktop\Abstract_Grafiken\2021-11-24_09h09_12.jpg$
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