[Midterm outcomes of transcatheter edge-to-edge repair mitral valve guided solely by transesophageal echocardiography].

Abstract

Objective: To preliminarily evaluate the efficacy and safety of transcatheter edge-to-edge repair of the mitral valve (MV-TEER) guided solely by transesophageal echocardiography (TEE). Methods: A total of 46 patients with mitral regurgitation who underwent MV-TEER guided solely by transesophageal echocardiography (TEE) at Central China Fuwai Hospital of Zhengzhou University from January 2023 to January 2024 were retrospectively enrolled. Follow-up was performed at 1, 3, 6, and 12 months after the procedure, including echocardiography, 6-minute walk test, New York Heart Association (NYHA) functional classification, and grading of mitral regurgitation severity. Hospitalization for heart failure, repeat mitral valve intervention, and all-cause mortality were recorded. The cumulative incidence of rehospitalization for heart failure was estimated using the Kaplan-Meier method. Results: The median age of the enrolled patients was 67.5 (59.0, 73.0) years, and 29 patients (63%) were male. MV-TEER was successfully performed under sole TEE guidance in all 46 patients. The median follow-up duration was 15.80 (12.63, 20.64) months. The 1-year rehospitalization rate for heart failure was 20%, and 1 patient died of malignant arrhythmia. There was no repeat mitral valve intervention. At 1 year after the procedure, the left ventricular end-systolic diameter decreased significantly from (47.17±11.31) mm to (39.71±7.44) mm (P<0.05). The left ventricular end-systolic volume decreased from (87.02±20.63) ml to (72.18±17.30) ml (P<0.05), and the left ventricular ejection fraction improved from (44.98±11.78)% to (51.84±10.03)% (P<0.05). Five patients had mitral regurgitation grade 3+, while the remaining patients had grade less than 3+. Three patients were in NYHA functional class Ⅲ, 23 in class Ⅱ, and 19 in class Ⅰ. The 6-minute walk distance improved significantly from (298±78) m to (375±70) m (P<0.05). Conclusion: It is preliminarily demonstrated that MV-TEER guided solely by TEE is safe and effective, and patients have favorable midterm outcomes.