Clin Res Cardiol (2023).

Gender-specific outcome and risk factors for all-cause mortality in patients undergoing transcatheter edge-to-edge-repair 
– A propensity score match analysis –
K. Diehl1, A. Ben Ammar1, P. Dierks1, U. Hanses1, A. Fach1, C. Frerker2, I. Eitel2, H. Wienbergen1, R. Hambrecht1, R. Osteresch1
1Bremer Institut für Herz- und Kreislaufforschung (BIHKF), Bremen; 2Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck;
Background: Knowledge regarding gender-specific results of transcatheter edge-to-edge mitral valve repair (M-TEER) is scarce and gender-specific risk factors for mortality are rarely available.
Objective:  The study sought to investigate gender-related differences in outcome and to evaluate gender-specific risk factors for worse prognosis in patients undergoing M-TEER. 
Methods: Consecutive patients with severe mitral regurgitation (MR) treated with M-TEER were included and followed prospectively. A propensity score match analysis was applied to evaluate gender-related differences in acute and long-term outcome.
Primary endpoint was all-cause mortality during a median follow-up period of 17±10 months. A multivariate Cox proportional-hazards regressions analysis was performed to identify gender-specific independent predictors for all-cause mortality.
Results: 626 patients (76±8.2 years; 262 women, 364 men) underwent M-TEER. Propensity-matched women and men achieved comparable significant rates of successful MR reduction (MR <2+) with similar in-hospital major adverse event rates. After propensity score matching women and men experienced similar rates of heart failure hospitalization (48.9% vs. 36.7%;log-rank p=0.27) and all-cause mortality (32.6% vs. 34.7%;log-rank p=0.71) at long-term follow-up.
In Cox regression analysis women and men showed different risk-factors for all-cause mortality.  Risk factors for women were NT-proBNP levels (hazard ratio (HR) 2.2; 95% confidence interval (CI) 1.36-3.7;p=0.002) atrial fibrillation (HR 4.9; 95% CI 1.49-15.37;p=0.009), diabetes mellitus (HR 6.2; 95% CI 1.9-19.6;p=0.002) and hypertension (HR 6.6; 95% CI 1.48-28.9;p=0.013) whereas left ventricular stroke work index (LVSWi; HR 0.94; 95% CI 0.91-0.97;p<0.001), tricuspid annular plane systolic excursion (TAPSE; HR 0.94; 95 CI 0.89-0.99;p=0.04), creatinine levels (HR 2.24; 95% CI 1.51-3.33;p>0.001) and previous aortic valve replacement (HR 7.8; 95% CI 2.19-27.72;p=0.02) were independent predictors for all-cause mortality in men.
Conclusions: Regardless of gender M-TEER is associated with immediate success and low in-hospital major adverse event rates. After propensity score matching men and women show similar survival rates at long-term follow-up. Different risk factors for all-cause mortality were identified for women and men, which might be of added value in patient selection for M-TEER.