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 language | English (US) |
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Article number | 101227 |
Pages (from-to) | 101227 |
Journal | JACC: Advances |
Volume | 3 |
Issue number | 10 |
DOIs | |
State | Published - Oct 2024 |
Keywords
- MVG
- MitraClip
- TEER
- TMPG
- mean gradient
- mitral repair
- outcomes
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Dentistry (miscellaneous)