Impact of systolic dominant pulmonary venous flow morphology on outcomes after mitral transcatheter edge-to-edge repair

Background:The prognostic significance of intraprocedural pulsed-wave Doppleranalysis of pulmonary venous flow (PVF) during mitral transcatheter edge-to-edgerepair (TEER) remains understudied. We aimed to investigate the prognostic value ofsystolic dominant-PVF (SD-PVF) morphology post-TEER.Methods:In a retrospective analysis from December 2019 to December 2022, pa-tients undergoing mitral TEER were categorized into SD-PVF and systolic blunting(SB)-PVF groups based on post-TEER morphology. The primary endpoint was acomposite of all-cause mortality or heart failure hospitalization at 1 year. Weinvestigated the association of PVF morphology post-TEER with the primary end-point at 1 year using Cox regression and compared the prognostic accuracy of PVFvariables through receiver operating characteristic (ROC) curve analysis.Results:Among 187 patients (mean age 76.4 +/- 10.5 years, 51.3% primary etiology),residual mitral regurgitation (MR)<= mild was observed in 147 (82.4%) patients and105 (56.2%) had SD-PVF post-TEER. Patients with SD-PVF had a lower incidence of>2+ residual MR after clip deployment, at 30 days (2.1% vs. 13.1%;p= 0.005) and at1 year (1.4% vs. 9%;p= 0.08). SD-PVF post-TEER was independently associatedwith the primary endpoint (HR = 0.59, 95% CI = 0.39-0.87;p= 0.009). ROC curveanalysis of the prognostic accuracy of SD-PVF demonstrated an AUC of 0.64 (95%CI = 0.54-0.73), comparable to other quantitative measures of PVF.Conclusion:Assessing PVF morphology after clip deployment offers a simpleprognostic tool for patients undergoing mitral TEER. Multicenter cohorts will benecessary to further investigate its prognostic value.