Temporal trend and potential impact of angiotensin receptor neprilysin inhibitors on transcatheter edge-to-edge mitral valve repair

Introduction and objectives: Transcatheter edge-to-edge repair (TEER) should be considered in patients with heart failure and secondary mitral regurgitation (MR). Angiotensin receptor-neprilysin inhibitors (ARNIs) have been demonstrated to improve prognosis in heart failure. We aimed to evaluate the impact ARNIs on patient selection and outcomes. Methods: The population of the Spanish TEER prospective registry (March 2012 to January 2021) was divided into 2 groups: a) TEER before the ARNI era (n = 450) and b) TEER after the recommendation of ARNIs by European Guidelines (n = 639), with further analysis according to intake (n = 52) or not (n = 587) of ARNIs. Results: A total of 1089 consecutive patients underwent TEER for secondary MR. In the ARNI era, there was a reduction in left ventricle dilation (82 mL vs 100 mL, P = .025), and better function (35% vs 38%, P = .011). At 2 years of follow-up, mortality (10.6% vs 17.3%, P < .001) and heart failure readmissions (16.6% vs 27.8%, P < .001) were lower in the ARNI era, but not recurrent MR. In the ARNI era, 1-and 2-year mortality were similar irrespective of ARNI intake but patients on ARNIs had a lower risk of readmission + mortality at 2 years (OR, 0.369; 95%CI, 0.137-0.992; P = .048), better NYHA class, and lower recurrence of MR III-IV (1.9% vs 14.3%, P = .011). Conclusions: Better patient selection for TEER has been achieved in the last few years with a parallel improvement in outcomes. The use of ARNIs was associated with a significant reduction in overall events, better NYHA class, and lower MR recurrence. (c) 2022 Sociedad Espantola de Cardiologa. Published by Elsevier Espanta, S.L.U. All rights reserved.