Transcatheter Edge-to-Edge Repair for Atrial and Ventricular Secondary Mitral Regurgitation: Insights From the REPAIR Study.

Philipp von Stein,Lukas Stolz,Jean Marc Haurand,Matthias Gröger,Felix Rudolph,Donika Mustafa,Jannik Jobst,Christoph Alexander Mues,Amir Abbas Mahabadi,Isabel A Hoerbrand,Carl Schulz,Atsushi Sugiura,Jennifer von Stein,Christos Iliadis,Philipp Lurz,Muhammed Gerçek,Patrick Horn,Mirjam Kessler,Guido Ascione,Tienush Rassaf,Marcel Weber,Niklas Schofer,Mathias Konstandin,Florian Schindhelm,Helge Möllmann,Bernhard Unsöld,Henning Guthoff,Stephan Baldus,Wolfgang Rottbauer,Volker Rudolph,Juan F Granada,Jörg Hausleiter,Roman Pfister,Victor Mauri,
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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
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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