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M-TEER for Secondary MR With Preserved LVEF
Quick Takes
- In patients with secondary MR (sMR) and preserved LVEF, M-TEER was associated with a high rate of technical success, low rate of major complications, and large improvements in health status at both 30 days and 1 year.
- Outcomes were comparable when compared to the outcomes of M-TEER in patients with sMR and LVEF of 20-50%.
- There was a graded relationship between the severity of residual MR and both death and HF hospitalization.
Study Questions:
What are the outcomes of mitral transcatheter edge-to-edge repair (M-TEER) in patients with secondary mitral regurgitation (sMR) and preserved left ventricular ejection fraction (LVEF)?
Methods:
The investigators evaluated the risk-adjusted outcomes of M-TEER for sMR with LVEF >50% by severity of residual MR using the STS/ACC TVT (Society of Thoracic Surgeons–American College of Cardiology Transcatheter Valve Therapy) Registry, and compared these outcomes to patients undergoing M-TEER for sMR with LVEF 20-50%. Clinical outcomes of this study included death and heart failure (HF) hospitalization within 1 year. The health status outcome was the Kansas City Cardiomyopathy Questionnaire–Overall Summary score (KCCQ-OS) at 30 days and 1 year. To study the 1-year risk of death between groups, a Cox proportional hazards model was fitted. Changes in KCCQ-OS within group, from baseline to 30 days and baseline to 1 year, were analyzed with Wilcoxon Signed Rank tests. Cross-sectional comparisons of mean KCCQ-OS scores at 30 days and 1 year after M-TEER were compared between groups using general linear models.
Results:
Among 12,083 patients, LVEF was >50% in 3,011 (24.9%) and 20-50% in 9,072 (75.1%). Technical success, in-hospital complications, 1-year death, and 1-year KCCQ were similar in patients with LVEF >50% versus LVEF 20-50%. The 1-year adjusted risk of HF hospitalization was lower in patients with LVEF >50% versus LVEF 20-50% (adjusted hazard ratio [aHR], 0.81; 95% confidence interval [CI], 0.68-0.97; p = 0.02). Among patients with LVEF >50%, residual MR was < mild in 76.0% and moderate in 19.0%. Compared with < mild MR, moderate residual MR was associated with increased 1-year risks of death (aHR, 1.46; 95% CI, 1.01-2.10; p = 0.04) and HF hospitalization (aHR, 1.82; 95% CI, 1.32-2.52; p < 0.001). At 1 year, KCCQ improved in patients with LVEF >50% treated with M-TEER (residual MR grade < mild 28.7 ± 26.8, moderate 25.7 ± 27.2, > moderate MR 21.6 ± 12.0, all p < 0.05).
Conclusions:
The authors report that in patients with sMR and preserved LVEF, M-TEER was associated with a high rate of technical success, low rate of complications, and large improvements in health status.
Perspective:
This retrospective cohort study reports that in patients with secondary MR and preserved LVEF, M-TEER was associated with a high rate of technical success, low rate of major complications, and large improvements in health status at both 30 days and 1 year. Furthermore, outcomes were comparable when compared to the outcomes of M-TEER in patients with sMR and LVEF of 20-50%. There was a graded relationship between the severity of residual MR and both death and HF hospitalization; in particular, patients who achieved < mild MR after M-TEER had the lowest risk of death or HF hospitalization at 1 year. These findings suggest M-TEER as a safe and effective treatment for patients with sMR and preserved LVEF. Additional prospective data would further support the role of M-TEER for patients with sMR and preserved LVEF.
Clinical Topics: Valvular Heart Disease, Mitral Regurgitation, Invasive Cardiovascular Angiography and Intervention
Keywords: Health Status, Heart Failure, Preserved Ejection Fraction, Mitral Valve Insufficiency, STS/ACC TVT Registry
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