Impact of Intraprocedural Mitral Regurgitation and Gradient Following Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation

被引：6

作者：

Ludwig, Sebastian ^{[1
,2
,3
]}

Koell, Benedikt ^{[1
,2
]}

Weimann, Jessica ^{[1
]}

Donal, Erwan ^{[4
]}

Dhairya, Patel ^{[5
]}

Stolz, Lukas ^{[6
]}

Tanaka, Tetsu ^{[7
]}

Scotti, Andrea ^{[8
]}

Trenkwalder, Teresa ^{[9
]}

Rudolph, Felix ^{[10
]}

Samim, Daryoush ^{[11
]}

von Stein, Philipp ^{[12
,13
]}

Giannini, Cristina ^{[14
]}

Dreyfus, Julien ^{[15
]}

Paradis, Jean-Michel ^{[16
]}

Adamo, Marianna ^{[17
,18
]}

Karam, Nicole ^{[19
]}

Bohbot, Yohann ^{[20
]}

Bernard, Anne ^{[21
]}

Melica, Bruno ^{[22
]}

Quagliana, Angelo ^{[23
]}

Badie, Yoan Lavie ^{[24
]}

Kessler, Mirjam ^{[25
]}

Chehab, Omar ^{[26
]}

Redwood, Simon ^{[26
]}

Lubos, Edith ^{[27
]}

Sondergaard, Lars ^{[23
]}

Metra, Marco ^{[17
,18
]}

Primerano, Chiara ^{[14
]}

Iliadis, Christos ^{[12
,13
]}

Praz, Fabien ^{[11
]}

Gercek, Muhammed ^{[10
]}

Xhepa, Erion ^{[9
]}

Nickenig, Georg ^{[7
]}

Latib, Azeem ^{[8
]}

Schofer, Niklas ^{[1
,2
]}

Makkar, Raj ^{[5
]}

Granada, Juan F. ^{[3
]}

Modine, Thomas ^{[28
]}

Hausleiter, Jorg ^{[19
]}

Kalbacher, Daniel ^{[1
,2
]}

Coisne, Augustin ^{[3
,29
]}

机构：

[1] Univ Med Ctr Hamburg Eppendorf, Univ Heart & Vasc Ctr Hamburg, Dept Cardiol, Hamburg, Germany

[2] German Ctr Cardiovasc Res DZHK, Partner Site Hamburg, Hamburg, Germany

[3] Cardiovasc Res Fdn, New York, NY 10019 USA

[4] Univ Rennes, CHU Rennes, INSERM, LTSI UMR 1099, Rennes, France

[5] Cedars Sinai Med Ctr, Smidt Heart Inst, Los Angeles, CA USA

[6] Klinikum Univ Munchen, Med Klin & Poliklin 2, Munich, Germany

[7] Heart Ctr Bonn, Dept Internal Med 2, Bonn, Germany

[8] Albert Einstein Coll Med, Monte fiore Einstein Ctr Heart & Vasc Care, Montefiore Med Ctr, Bronx, NY USA

[9] Tech Univ Munich, German Heart Ctr Munich, Dept Cardiol, Munich, Germany

[10] Heart & Diabet Ctr North RhineWestphalia NRW, Clin Gen & Intervent Cardiol Angiol, Bad Oeynhausen, Germany

[11] Inselspital Bern, Univ Klin Kardiol, Bern, Switzerland

[12] Univ Cologne, Fac Med, Dept Internal Med 3, Cologne, Germany

[13] Univ Hosp Cologne, Univ Cologne, Cologne, Germany

[14] Azienda Osped Univ Pisana, SD Emodinam, Pisa, Italy

[15] Ctr Cardiol Nord, Cardiol Dept, Paris, France

[16] Laval Univ, Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[17] Univ Brescia, Cardiac Catheterizat Lab & Cardiol, ASST Spedali Civili, Brescia, Italy

[18] Radiol Sci & Publ Hlth, Dept Med & Surg Specialties, Brescia, Italy

[19] Hop Europeen Georges Pompidou, Cardiol Dept, Paris, France

[20] Amiens Univ Hosp, Dept Cardiol, Amiens, France

[21] Univ Tours, ToursUnivers Hosp, Cardiol Dept, INSERM ISCHEMIA UMR1327, Tours, France

[22] Ctr Hosp Vila Nova Gaia, Espinho, Portugal

[23] Copenhagen Univ Hosp Copenhagen, Rigshospitalet, Copenhagen, Denmark

[24] Rangueil Univ Hosp, Dept Cardiol, Toulouse, France

[25] Ulm Univ, Dept Internal Medicine2, Heart Ctr, Ulm, Germany

[26] St Thomas Hosp, Dept Cardiol, London, England

[27] Marien Hosp, Hamburg, Germany

[28] CHU Bordeaux, Serv Med-Chirurg Valvulopath Chirurg Cardiaque Car, Bordaux, France

[29] CHU Lille, Heart Valve Clin, Dept Clin Physiol & Echocardiog, Lille, France

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2024年 / 17卷 / 13期

关键词：

KEY WORDS mitral valve; primary mitral regurgitation; residual mitral regurgitation; transcatheter edge-to-edge repair; VALVE PRESSURE-GRADIENT;

D O I：

10.1016/j.jcin.2024.05.018

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The impact of intraprocedural results following transcatheter edge-to-edge repair (TEER) in primary mitral regurgitation (MR) is controversial. OBJECTIVES This study sought to investigate the prognostic impact of intraprocedural residual mitral regurgitation (rMR) and mean mitral valve gradient (MPG) in patients with primary MR undergoing TEER. METHODS The PRIME-MR (Outcomes of Patients Treated With Mitral Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation) registry included consecutive patients with primary MR undergoing TEER from 2008 to 2022 at 27 international sites. Clinical outcomes were assessed according to intraprocedural rMR and mean MPG. Patients were categorized according to rMR (optimal result: <= 1+, suboptimal result: >= 2+) and MPG (low gradient: <= 5 mm Hg, high gradient: > 5 mm Hg). The prognostic impact of rMR and MPG was evaluated in a Cox regression analysis. The primary endpoint was 2-year all-cause mortality or heart failure hospitalization. RESULTS Intraprocedural rMR and mean MPG were available in 1,509 patients (median age = 82 years [Q1-Q3: 76.086.0 years], 55.1% male). Kaplan-Meier analysis according to rMR severity showed signi ficant differences for the primary endpoint between rMR <= 1+ (29.1%), 2+ (41.7%), and >= 3+ (58.0%; P < 0.001), whereas there was no difference between patients with a low (32.4%) and high gradient (42.1%; P = 0.12). An optimal result/low gradient was achieved in most patients (n = 1,039). The worst outcomes were observed in patients with a suboptimal result/high gradient. After adjustment, rMR >= 2+ was independently linked to the primary endpoint (HR: 1.87; 95% CI: 1.32-2.65; P < 0.001), whereas MPG >5 mm Hg was not (HR: 0.78; 95% CI: 0.47-1.31; P = 0.35). CONCLUSIONS Intraprocedural rMR but not MPG independently predicted clinical outcomes following TEER for primary MR. When performing TEER in primary MR, optimal MR reduction seems to outweigh the impact of high transvalvular gradients. (JACC Cardiovasc Interv 2024;17:1559 -1573) (c) 2024 by the American College of Cardiology Foundation.

引用

页码：1559 / 1573

页数：15

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