Transcatheter Edge-to-Edge Repair for Atrial and Ventricular Secondary Mitral Regurgitation

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-08-25 DOI:10.1016/j.jcin.2025.05.031

Philipp von Stein MD , Lukas Stolz MD , Jean Marc Haurand MD , Matthias Gröger MD , Felix Rudolph MD , Donika Mustafa Cand Med , Jannik Jobst MD , Christoph Alexander Mues MD , Amir Abbas Mahabadi MD , Isabel A. Hoerbrand MD , Carl Schulz MD , Atsushi Sugiura MD , Jennifer von Stein MD , Christos Iliadis MD , Philipp Lurz MD , Muhammed Gerçek MD , Patrick Horn MD , Mirjam Kessler MD , Guido Ascione MD , Tienush Rassaf MD , Laila Widmann MD

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引用次数: 0

Abstract

Background

Secondary mitral regurgitation (SMR) has 2 phenotypes: atrial (aSMR) and ventricular (vSMR). The role of mitral valve transcatheter edge-to-edge repair (M-TEER) in aSMR remains less defined, with limited evidence on the PASCAL implant (Edwards Lifesciences).

Objectives

The authors sought to evaluate and compare outcomes of SMR phenotypes undergoing M-TEER.

Methods

REPAIR (REgistry of PAscal for mItral Regurgitation) is an investigator-initiated, multicenter registry of patients undergoing M-TEER. aSMR was defined by left atrial dilation with preserved left ventricular size and ejection fraction. Outcomes included MR ≤1+ at discharge, technical success, NYHA functional class improvement, and 1-year survival.

Results

Among 915 patients (166 [18%] aSMR, 749 [82%] vSMR), the median follow-up was 491 days (Q1-Q3: 360-833 days). MR ≤1+ was achieved in 77.2% vs 71.4% (P = 0.162), with technical success in 97.0% vs 98.3% (P = 0.446). NYHA functional class improved in both phenotypes (P < 0.001), with 61.2% vs 61.3% in functional class ≤II at follow-up (P > 0.999). One-year survival was 88.4% (95% CI: 82.8%-94.4%) vs 86.0% (95% CI: 83.1%-89.0%; P = 0.346). In aSMR patients, 1-year survival was significantly lower in patients with baseline tricuspid regurgitation (TR) grade ≥moderate compared with those with <moderate TR (84.3% [95% CI: 77.0%-92.3%] vs 100.0% [95% CI: 100.0%-100.0%]; P = 0.041). In vSMR patients, survival was similar between ≥moderate and <moderate baseline TR (83.9% [95% CI: 79.8%-88.2%] vs 89.3% [95% CI: 85.0%-93.8%]; P = 0.051).

Conclusions

M-TEER effectively reduces MR to ≤1+ and improves symptoms in both aSMR and vSMR. Particularly in aSMR, ≥moderate baseline TR is linked to worse outcomes, warranting consideration as an additional treatment target.

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经导管边缘到边缘修复心房和心室继发性二尖瓣反流：来自修复研究的见解。

背景继发性二尖瓣反流（SMR）有两种表型：心房（aSMR）和心室（vSMR）。二尖瓣经导管边缘到边缘修复（M-TEER）在aSMR中的作用尚未明确，PASCAL植入物的证据有限（Edwards生命科学公司）。目的作者试图评估和比较SMR表型接受M-TEER的结果。方法srepair（二尖瓣反流的PAscal注册）是一项由研究者发起的、多中心的M-TEER患者注册。aSMR的定义是左心房扩张并保留左心室大小和射血分数。结果包括出院时MR≤1+、技术成功、NYHA功能分级改善和1年生存率。结果915例患者（166例[18%]aSMR， 749例[82%]vSMR）中位随访时间为491天（Q1-Q3: 360-833天）。MR≤1+的成功率77.2% vs 71.4% (P = 0.162)，技术成功率97.0% vs 98.3% （P = 0.446）。两种表型的NYHA功能分级均有改善（P < 0.001），随访时功能分级≤II的NYHA功能分级分别为61.2%和61.3% （P < 0.999）。一年生存率为88.4% (95% CI: 82.8%-94.4%) vs 86.0% (95% CI: 83.1%-89.0%；P = 0.346)。在aSMR患者中，基线三尖瓣反流（TR）等级≥中度的患者的1年生存率显著低于TR <中度的患者(84.3% [95% CI: 77.0%-92.3%] vs 100.0% [95% CI: 100.0%-100.0%]；P = 0.041)。在vSMR患者中，≥中度和<中度基线TR患者的生存率相似(83.9% [95% CI: 79.8%-88.2%] vs 89.3% [95% CI: 85.0%-93.8%]；P = 0.051)。结论sm - teer可有效降低aSMR和vSMR的MR至≤1+，改善症状。特别是在aSMR中，≥中等的基线TR与较差的结果相关，值得考虑作为额外的治疗目标。

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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.