Pulmonary hypertension and transcatheter edge-to-edge mitral valve repair – long-term outcome with focus on new guideline definition

Timm Benjamin Ubben (Hamburg)1, C. Frerker (Lübeck)2, B. Fujita (Lübeck)3, S. Rosenkranz (Köln)4, R. Pfister (Köln)4, S. Baldus (Köln)5, H. Alessandrini (Lübeck)2, K.-H. Kuck (Hamburg)6, S. Willems (Hamburg)1, I. Eitel (Lübeck)2, T. Schmidt (Lübeck)2

1Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; 2Universitätsklinikum Schleswig-Holstein Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin Lübeck, Deutschland; 3Universitätsklinikum Schleswig-Holstein Klinik für Herz- und thorakale Gefäßchirurgie Lübeck, Deutschland; 4Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 5Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 6LANS Cardio Hamburg Kardiologie Hamburg, Deutschland


Objectives: The impact of pulmonary hypertension (PH) on outcome after mitral transcatheter edge-to-edge repair (M-TEER) focusing on the new ESC/ERS guidelines definition for PH.

Background: PH is frequently found in patients with mitral regurgitation and is associated with lower survival rates. Recent studies were based on echocardiographic parameters, but results based on invasive hemodynamics differentiating distinct types of PH using the new definition for PH are missing.  

Methods: A total of 449 M-TEER patients successfully treated at our center between 12/2009 and 2/2015 were analyzed. All patients were stratified by the distinct types of PH according to the definitions of the ESC/ERS guidelines for the diagnosis of PH from 2015  and 2022.

Results: Patients with any type of PH showed a significantly lower survival after M-TEER compared to patients with no PH (2015: HR 1.61 (95%CI1.25-2.07); p<0.001 and 2022: HR 2.09 (95%CI1.54-2.83); p<0.001, Fig. 1). Based on the new PH definition each PH subgroup showed a lower survival after M-TEER compared to patients with no PH (Fig. 2). Patients with mPAP >20 mmHg but <25mmHg were classified as having PH according to the new definition. Those patients (mPAP >21-24 mmHg) showed a significantly lower survival than patients with no PH (mPAP ≤20 mmHg, p=0.003), while survival in this group was comparable to patients with PH according to the 2015 guidelines (mPAP ≥25 mmHg, p=0.32; Fig. 3). Echocardiographic estimated systolic PAP showed a correlation with invasively measured mPAP (r=0.29,p<0.001) and sPAP (r=0.34,p<0.001). Cox-regression analysis showed higher diastolic, systolic and mean pulmonary pressures being associated with higher mortality (p<0.001). In addition, higher right atrial pressure, lower pulmonary arterial compliance, higher pulmonary vascular resistance and higher wedge pressure were identified as predictors of mortality after M-TEER. 

Conclusions: The new PH definition discriminates PH groups and mortality better than the old definition. The lower threshold of mPAP of 20mmHg improved prognostication in this cohort of patients.

Fig. 1

Fig. 2

Fig. 3

Diese Seite teilen