Impact of Residual Transmitral Mean Pressure Gradient on Outcomes After Mitral Transcatheter Edge-to-Edge Repair

Yasser M. Sammour, Rody G. Bou Chaaya, Taha Hatab, Syed Zaid, Joe Aoun, Priscilla Wessly, Chloe Kharsa, William A. Zoghbi, Sherif Nagueh, Marvin D. Atkins, Michael J. Reardon, Nadeen Faza, Stephen H. Little, Neal S. Kleiman, Sachin S. Goel

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND: There is conflicting evidence regarding the effect of residual transmitral mean pressure gradient (TMPG) after mitral transcatheter edge-to-edge repair (M-TEER). Different TMPG cutoffs have been employed in prior studies with varying results.

OBJECTIVES: The purpose of this study was to examine the association between residual TMPG and M-TEER outcomes.

METHODS: Consecutive patients undergoing M-TEER at our institution between 2014 and 2022 were included and divided based on quartiles of predischarge TMPG. Outcomes were assessed using Kaplan-Meier analysis and Cox proportional hazard models. We performed subgroup analyses according to mitral regurgitation (MR) mechanism. The primary outcome was all-cause mortality or heart failure hospitalization.

RESULTS: We included 283 patients (age 76.7 ± 10.8 years, 42.8% women, 78.4% Caucasian, and baseline TMPG 2.4 ± 1.3 mm Hg). Higher baseline TMPG was a predictor of increased TMPG after M-TEER (coefficient 0.60 [95% CI: 0.40-0.70]; P < 0.001). In comparison with predischarge TMPG quartiles 1 to 3, those in quartile 4 (7.0 ± 1.1 mm Hg) had an increased risk of 3-year all-cause mortality or heart failure hospitalization (adjHR: 1.53 [95% CI: 1.03-2.26]; P = 0.034), as well as all-cause mortality alone (adjusted HR [adjHR]: 1.68 [95% CI: 1.09-2.60]; P = 0.020). Among patients with primary MR, similar findings were seen for the composite endpoint (adjHR: 2.08 [95% CI: 1.15-3.77]; P = 0.016), and all-cause mortality (adjHR: 2.70 [95% CI: 1.40-5.19]; P = 0.003). However, this association did not reach statistical significance in secondary MR.

CONCLUSIONS: In this single-center study, higher residual TMPG after M-TEER was associated with worse outcomes at intermediate- to long-term follow-up. The effect was mainly driven by increased mortality especially in patients with primary MR. Operators should strive to lower residual TMPG before the conclusion of the procedure.

Original languageEnglish (US)
Article number101227
Pages (from-to)101227
JournalJACC: Advances
Volume3
Issue number10
DOIs
StatePublished - Oct 2024

Keywords

  • MVG
  • MitraClip
  • TEER
  • TMPG
  • mean gradient
  • mitral repair
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Dentistry (miscellaneous)

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