Association of Baseline Mitral Valve Area With Procedural and Clinical Outcomes of Mitral Transcatheter Edge-to-Edge Repair: Insights From the OCEAN-Mitral Registry.

IF 6.1 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Circulation: Cardiovascular Interventions Pub Date : 2024-12-01 Epub Date: 2024-12-17 DOI:10.1161/CIRCINTERVENTIONS.124.014420

Kazunori Mushiake, Shunsuke Kubo, Sachiyo Ono, Takeshi Maruo, Naoki Nishiura, Kohei Osakada, Kazushige Kadota, Masanori Yamamoto, Mike Saji, Masahiko Asami, Yusuke Enta, Masaki Nakashima, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Junichi Yamaguchi, Yuki Izumi, Toru Naganuma, Hiroki Bota, Yohei Ohno, Masahiro Yamawaki, Hiroshi Ueno, Kazuki Mizutani, Toshiaki Otsuka, Kentaro Hayashida

{"title":"Association of Baseline Mitral Valve Area With Procedural and Clinical Outcomes of Mitral Transcatheter Edge-to-Edge Repair: Insights From the OCEAN-Mitral Registry.","authors":"Kazunori Mushiake, Shunsuke Kubo, Sachiyo Ono, Takeshi Maruo, Naoki Nishiura, Kohei Osakada, Kazushige Kadota, Masanori Yamamoto, Mike Saji, Masahiko Asami, Yusuke Enta, Masaki Nakashima, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Junichi Yamaguchi, Yuki Izumi, Toru Naganuma, Hiroki Bota, Yohei Ohno, Masahiro Yamawaki, Hiroshi Ueno, Kazuki Mizutani, Toshiaki Otsuka, Kentaro Hayashida","doi":"10.1161/CIRCINTERVENTIONS.124.014420","DOIUrl":null,"url":null,"abstract":"Background: A small mitral valve area (MVA) is one of the challenging anatomies for transcatheter edge-to-edge repair (TEER) for mitral regurgitation, but the relationship between baseline MVA and clinical outcomes remains unknown. This study aimed to evaluate the association of baseline MVA with procedural and clinical outcomes in patients undergoing TEER with MitraClip from the OCEAN-Mitral registry (Optimized Catheter Valvular Intervention-Mitral).Methods: A total of 1768 patients undergoing TEER were divided into 3 groups according to baseline MVA: group 1: <4.0 cm2, n=358; group 2: 4.0-5.0 cm2, n=493; and group 3: ≥5.0 cm2, n=917. The primary end point was a composite of all-cause death and heart failure hospitalization within 2 years of TEER and compared between the 3 groups.Results: Patients with smaller MVA had significantly fewer clips implanted and higher postprocedural transmitral mean pressure gradient. There was no significant difference in the acute procedural success rate and postprocedural mitral regurgitation severity between the 3 groups. The incidence of the primary end point was similar in group 1 compared with groups 2 and 3 (35.2% versus 34.5% versus 34.0%; P=0.96) and was also similar in patients with MVA <3.5 cm2 and those with MVA 3.5 to 4.0 cm2. The adjusted risk of MVA <4.0 cm2 relative to MVA of 4.0 to 5.0 cm2 and MVA ≥5 cm2 for the primary end point remained insignificant (hazard ratio, 1.06 [95% CI, 0.79-1.41]; P=0.68; hazard ratio, 0.99 [95% CI, 0.75-1.31]; P=0.96, respectively). At 1 year, no significant difference in the proportion of residual mitral regurgitation 3+/4+ was observed between the 3 groups (7.2% versus 4.4% versus 6.5%; P=0.49).Conclusions: In patients undergoing TEER, a small MVA <4.0 cm2 may limit the number of clips implanted and increase the transmitral pressure gradient after TEER, but baseline MVA was not associated with mitral regurgitation reduction and clinical outcomes.Registration: URL: https://center6.umin.ac.jp/cgiope n-bin/ctr/ctr_view.cgi?recptno=R000027188; Unique identifier: UMIN000023653.","PeriodicalId":10330,"journal":{"name":"Circulation: Cardiovascular Interventions","volume":"17 12","pages":"e014420"},"PeriodicalIF":6.1000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCINTERVENTIONS.124.014420","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/17 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: A small mitral valve area (MVA) is one of the challenging anatomies for transcatheter edge-to-edge repair (TEER) for mitral regurgitation, but the relationship between baseline MVA and clinical outcomes remains unknown. This study aimed to evaluate the association of baseline MVA with procedural and clinical outcomes in patients undergoing TEER with MitraClip from the OCEAN-Mitral registry (Optimized Catheter Valvular Intervention-Mitral).

Methods: A total of 1768 patients undergoing TEER were divided into 3 groups according to baseline MVA: group 1: <4.0 cm², n=358; group 2: 4.0-5.0 cm², n=493; and group 3: ≥5.0 cm², n=917. The primary end point was a composite of all-cause death and heart failure hospitalization within 2 years of TEER and compared between the 3 groups.

Results: Patients with smaller MVA had significantly fewer clips implanted and higher postprocedural transmitral mean pressure gradient. There was no significant difference in the acute procedural success rate and postprocedural mitral regurgitation severity between the 3 groups. The incidence of the primary end point was similar in group 1 compared with groups 2 and 3 (35.2% versus 34.5% versus 34.0%; P=0.96) and was also similar in patients with MVA <3.5 cm² and those with MVA 3.5 to 4.0 cm². The adjusted risk of MVA <4.0 cm² relative to MVA of 4.0 to 5.0 cm² and MVA ≥5 cm² for the primary end point remained insignificant (hazard ratio, 1.06 [95% CI, 0.79-1.41]; P=0.68; hazard ratio, 0.99 [95% CI, 0.75-1.31]; P=0.96, respectively). At 1 year, no significant difference in the proportion of residual mitral regurgitation 3+/4+ was observed between the 3 groups (7.2% versus 4.4% versus 6.5%; P=0.49).

Conclusions: In patients undergoing TEER, a small MVA <4.0 cm² may limit the number of clips implanted and increase the transmitral pressure gradient after TEER, but baseline MVA was not associated with mitral regurgitation reduction and clinical outcomes.

Registration: URL: https://center6.umin.ac.jp/cgiope n-bin/ctr/ctr_view.cgi?recptno=R000027188; Unique identifier: UMIN000023653.

查看原文本刊更多论文

基线二尖瓣面积与二尖瓣经导管边缘到边缘修复的手术和临床结果的关系：来自ocean -二尖瓣注册的见解。

背景：小二尖瓣面积（MVA）是二尖瓣反流经导管边缘到边缘修复（TEER）的一个具有挑战性的解剖结构，但基线MVA与临床结果之间的关系尚不清楚。本研究旨在评估基线MVA与在ocean -二尖瓣登记（优化导管瓣膜介入-二尖瓣）中使用MitraClip的TEER患者的手术和临床结果的关系。方法：1768例TEER患者根据基线MVA分为3组：1组：2组，n=358；第二组：4.0-5.0 cm2, n=493；第三组：≥5.0 cm2, n=917。主要终点是TEER发生后2年内全因死亡和心力衰竭住院的综合数据，并在3组之间进行比较。结果：MVA越小的患者植入夹越少，术后平均压力梯度越高。三组患者急性手术成功率及术后二尖瓣返流严重程度比较，差异均无统计学意义。与2、3组相比，1组的主要终点发生率相似(35.2% vs . 34.5% vs . 34.0%；P=0.96)， MVA 2和MVA 3.5 ~ 4.0 cm2的患者也相似。主要终点MVA 2相对于MVA 4.0 ~ 5.0 cm2和MVA≥5 cm2的校正风险仍然不显著(风险比为1.06 [95% CI, 0.79-1.41]；P = 0.68;风险比，0.99 [95% CI, 0.75-1.31]；分别为P = 0.96)。1年后，三组间二尖瓣残余返流3+/4+的比例无显著差异(7.2% vs 4.4% vs 6.5%；P = 0.49)。结论：在接受TEER的患者中，较小的MVA 2可能会限制植入夹的数量并增加TEER后的传递压力梯度，但基线MVA与二尖瓣反流减少和临床结果无关。注册地址：https://center6.umin.ac.jp/cgiope n-bin/ctr/ctr_view.cgi?recptno=R000027188；唯一标识符：UMIN000023653。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

1.80%

发文量

221

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.