Long-Term Outcomes After Edge-to-Edge Repair of Secondary Mitral Regurgitation

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2024-11-11 DOI:10.1016/j.jcin.2024.08.016

Thomas J. Stocker MD , Lukas Stolz MD , Nicole Karam MD, PhD , Daniel Kalbacher MD , Benedikt Koell MD , Teresa Trenkwalder MD , Erion Xhepa MD , Marianna Adamo MD , Maximilian Spieker MD , Patrick Horn MD , Christian Butter MD , Ludwig T. Weckbach MD , Julia Novotny MD , Bruno Melica MD , Christina Giannini MD , Ralph Stephan von Bardeleben MD , Roman Pfister MD , Fabien Praz MD , Philipp Lurz MD, PhD , Volker Rudolph MD , Francisco Sampaio MD

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引用次数: 0

Abstract

Background

Mitral valve transcatheter edge-to-edge repair (M-TEER) reduces secondary mitral regurgitation (MR) in heart failure and impacts survival in selected patients as demonstrated in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. However, long-term outcome data after M-TEER under real-world conditions are lacking.

Objectives

This study sought to assess long-term efficacy and survival after M-TEER in a large real-world registry.

Methods

We analyzed patients with significant secondary MR undergoing M-TEER from the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry. Long-term MR reduction, functional outcomes, survival rate, and predictors for all-cause mortality were assessed.

Results

In this study, 1,628 patients undergoing M-TEER (mean age 73.8 years, mean EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 6.9%, 86.6% NYHA functional class ≥III) with available long-term data were included. Five-year survival was 35.0%. Long-term MR reduction (MR grade ≤2+: baseline 4.1%, discharge 92.2%, 5-year follow-up 85.5%; P < 0.001) and functional improvement (NYHA ≤II: baseline 13.4%, 5-year follow-up 60.1%; P < 0.001) was observed. The degree of residual MR was associated with 5-year survival (residual MR grade ≤1+: 38.6%; 2+: 30.5%; ≥3+: 22.6%; P < 0.001). Independent predictors for 5-year all-cause mortality post–M-TEER included age, renal function, residual MR, NYHA functional class, left ventricular ejection-fraction, and COAPT trial eligibility (P < 0.01 for all).

Conclusions

This extensive multicenter registry underscores the long-term efficacy of M-TEER in real-world clinical practice and identifies predictors for long-term survival. These findings contribute valuable insights for optimizing patient selection in routine clinical interventions.

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继发性二尖瓣反流边缘到边缘修复术后的长期疗效：欧洲二尖瓣反流注册的 5 年结果。

背景：二尖瓣经导管边缘到边缘修补术（M-TEER）可减少心衰患者的继发性二尖瓣反流（MR），并影响特定患者的生存，COAPT（MitraClip经皮疗法治疗功能性二尖瓣反流心衰患者的心血管效果评估）试验证明了这一点。然而，M-TEER术后在真实世界条件下的长期疗效数据还很缺乏：本研究试图在一个大型真实世界登记处评估 M-TEER 术后的长期疗效和存活率：我们分析了 EuroSMR（欧洲继发性二尖瓣反流经导管修复注册）注册机构中接受 M-TEER 的严重继发性 MR 患者。评估了MR的长期缓解情况、功能预后、存活率以及全因死亡率的预测因素：在这项研究中，共纳入了1628名接受M-TEER的患者（平均年龄73.8岁，平均EuroSCORE II[欧洲心脏手术风险评估系统II]6.9%，86.6%的NYHA功能分级≥III），这些患者均有长期数据。五年生存率为 35.0%。观察到长期 MR 减少（MR 等级≤2+：基线 4.1%，出院 92.2%，5 年随访 85.5%；P < 0.001）和功能改善（NYHA ≤II：基线 13.4%，5 年随访 60.1%；P < 0.001）。残留 MR 的程度与 5 年生存率相关（残留 MR 等级≤1+：38.6%；2+：30.5%；≥3+：22.6%；P <0.001）。M-TEER术后5年全因死亡率的独立预测因素包括年龄、肾功能、残余MR、NYHA功能分级、左心室射血分数和COAPT试验资格（P<0.01）：这项广泛的多中心登记强调了M-TEER在实际临床实践中的长期疗效，并确定了长期生存的预测因素。这些发现为优化常规临床干预中的患者选择提供了有价值的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.