Edge-to-Edge mitral valve repair for preoperative bridging to heart transplantation

Abstract

Transcatheter edge-to-edge repair (TEER) is a less invasive alternative to mitral valve surgery. In patients with advanced heart failure (HF), TEER can improve pulmonary hypertension (PH) and decelerate the progression of HF. TEER could be considered as a possible bridging strategy before orthotopic heart transplantation (OHT) in suitable patients. We report our experience in patients with advanced HF and severe functional mitral regurgitation (FMR) who underwent TEER prior to OHT. In this retrospective single-center study, we evaluated the periprocedural characteristics and clinical and hemodynamic outcomes of 14 patients with advanced HF on guideline-directed medical therapy and severe FMR who underwent TEER prior to OHT. In 6 patients who were not eligible for transplantation because of PH, TEER was performed as bridge-to-candidacy (BTC) strategy, in 8 unstable patients on the waiting list as bridge-to-transplant (BTT) strategy.

Severity of FMR was reduced by 2 degrees from 4 (3–4) to 2 (1.25–2.25) (p < 0.001), NYHA class from 3 (2–3) to 2 (1.75–2.13) (p = 0.003) and NT-proBNP from 4689 (2841–7932) ng/L to 2973 (1694–4812) ng/L (p = 0.008). Significant reduction in PH was observed in the BTC cohort (mean PAP from 50 (39–53) to 26 (23–33) (p = 0.027) and PCWP from to 34 (29–40) to 13.5 (11–21) mmHg (p = 0.027). 13 patients underwent successful OHT, 1 patient of the BTT cohort died of sepsis shortly after HTX listing. In conclusion patients with advanced HF and severe FMR who are considered for OHT, TEER appears suitable both as a BTC strategy in patients with PH and as a BTT strategy in unstable patients on the waiting list.