One-year Outcomes Stratified by Gradient and Residual Mitral Regurgitation (MR) after Transcatheter Edge-to-Edge Repair in Degenerative MR: Results from the CLASP IID Trial

J. Hausleiter (München)¹, A. Narang (IL)², D. S. Lim (VA)³, R. L. Smith (TX)⁴, F. Zahr (OR)⁵, S. Chadderdon (OR)⁵, J. Puthumana (IL)², R. Makkar (Californien)⁶, M. M. Makar (CA)⁷, R. S. von Bardeleben (Mainz)⁸, T. Ruf (Mainz)⁹, T. Gößler (Mainz)⁹, R. M. Kipperman (NJ)¹⁰, A. N. Rassi (CA)¹¹, I. A. Ku (CA)¹¹, M. Näbauer (München)¹, M. Szerlip (TX)⁴, Z. Wang (TX)⁴, S. Goldman (PA)¹², K. M. Hawthorne (PA)¹², K. Koulogiannis (NJ)¹⁰, L. Marcoff (NJ)¹⁰, L. D. Gillam (NJ)¹⁰, C. J. Davidson (IL)^2
1LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; ²Bluhm Cardiovascular Institute, Northwestern University IL, USA; ³University of Virginia Health System Hospital VA, USA; ⁴Baylor Scott and White: The Heart Hospital TX, USA; ⁵Oregon Health & Science University OR, USA; ⁶Cedars-Sinai Medical Center Californien, USA; ⁷Cedars-Sinai Medical Center CA, USA; ⁸Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie im Herz- und Gefäßzentrum Mainz, Deutschland; ⁹Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; ¹⁰Atlantic Health System Morristown Medical Center NJ, USA; ¹¹Kaiser Permanente San Francisco Medical Center CA, USA; ¹²Lankenau Medical Center PA, USA

Background: Optimal reduction of mitral regurgitation (MR) in mitral transcatheter edge-to-edge repair (M-TEER) improves patient outcomes and is balanced against elevated transmitral gradients (TMG). Understanding the implications of MR optimization and TMG informs procedural strategies.

Methods: One-year outcomes from the randomized CLASP IID trial (NCT03706833) were analyzed by discharge TMG ≤5 vs. >5 mmHg and discharge MR ≤1+ vs. ≥2+ in prohibitive surgical risk patients with 3+/ 4+ degenerative MR (DMR).

Results: The analysis included 284 patients divided into 4 groups, TMG ≤5 and MR ≤1+: 72.5% patients (n=206), TMG >5 and MR ≤1+: 11.6% (n=33), TMG ≤5 and MR ≥2+: 11.3% (n=32), and TMG >5 and MR ≥2+: 4.6% (n=13). Baseline characteristics were similar between groups. At 1 year, the composite rate of survival, and freedom from heart failure hospitalization or non-elective mitral valve reintervention was significantly different (P=0.011, Fig). All groups had significant reduction in LV diastolic and systolic volumes (all P<0.05 vs. baseline, and baseline adjusted inter-group P=0.193 and 0.751, respectively), and a high proportion were New York Heart Association Class I/II (range: 80.0 to 90.0%, all P<0.05 vs. baseline, inter-group P=0.443).

Conclusions: In DMR patients treated with M-TEER in the CLASP IID trial, achieving discharge MR ≤1+ was more impactful in improving clinical outcomes than maintaining gradients ≤5 mmHg, suggesting a benefit of optimizing MR over preserving lower gradients.