Background: Transcatheter edge-to-edge mitral valve repair (mTEER) is an effective treatment modality for patients with severe mitral regurgitation (MR) at prohibitive risk for surgery. While residual moderate-to-severe residual MR constitutes a marker of diminished long-term survival, the impact of residual moderate MR (II°) on survival remains unclear. Regardless from this, it seems reasonable to aim for the greatest possible reduction in MR to a residual mild or minimal severity (≤I°) in the context of mTEER. However, preliminary predictors of residual MR ≤I° have not yet been investigated yet.
Methods: All patients who underwent mTEER in four german cardiac centers were investigated. Patients were assigned to the respective cohorts with and without residual MR ≤I°. Predictors of residual MR ≤I° were identified via uni- and multivariable logistic regression analyses. Long-term survival was compared via the Kaplan-Meier method between both cohorts after adjustment of confounders via propensity-score-matching (PSM) in a 1:6-ratio.
Results: A total of 821 patients were enrolled for analysis, 724 (88.2%) of whom achieved residual MR ≤I°, and 97 (11.8%) achieved residual MR of II°. Patients with residual MR II° were younger, more morbid and required longer procedure times, as outlined in
Table 1. Univariable logistic regression analysis identified age <65 years (odds ratio [OR] 0.39, 95%-confidence interval [CI] 0.2-0.79, p=0.005), prior implantable cardioverter defibrillator therapy (ICD, OR 0.56, 95%-CI 0.36-0.91, p=0.02) and a left ventricular enddiastolic diameter >62 mm (OR 0.52, 95%-CI 0.31-0.88, p=0.01) as inverse predictors of residual MR ≤I°. Within the multivariable logistic regression analysis, age <65 years remained as inverse predictor of residual MR ≤I° (OR 0.39, 95%-CI 0.19-0.84, p=0.01), as presented in
Table 2. A balancing of the variables with previously significant differences between both cohorts was achieved through PSM. Nevertheless, survival did not differ significantly between patients with residual MR II° and MR ≤I° before and after PSM, which was further illustrated in
Figure 1.
Conclusion: Residual MR of II° was common in 11.8% (97/821) of today’s mTEER patients. While survival was not affected, the identified predictors of residual MR ≤I° can provide guidance in the selection of suitable candidates in the contemporary mTEER era.
Figure 1: Long-term survival between patients with and without residual MR ≤I° after PSM
