Mitral Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation With Preserved Left Ventricular Function.

Background: Outcomes of mitral transcatheter edge-to-edge repair (MTEER) in patients with secondary mitral regurgitation (sMR) and preserved left ventricular ejection fraction (LVEF) are uncertain.
Objectives: This study sought to describe outcomes of MTEER for sMR with preserved LVEF.
Methods: Using the STS/ACC TVT (Society of Thoracic Surgeons-American College of Cardiology Transcatheter Valve Therapy) Registry, we evaluated the risk-adjusted outcomes of MTEER for sMR with LVEF >50% by the severity of residual mitral regurgitation (MR), and we compared these outcomes to patients undergoing MTEER for sMR with LVEF of 20% to 50%.
Results: Among 12,083 patients, LVEF was >50% in 3,011 (24.9%) and 20% to 50% in 9,072 (75.1%). Technical success, in-hospital complications, the 1-year death rate, and the 1-year Kansas City Cardiomyopathy Questionnaire score were similar in patients with LVEF >50% vs LVEF of 20% to 50%. The 1-year adjusted risk of heart failure hospitalization was lower in patients with LVEF >50% vs LVEF of 20% to 50% (adjusted HR: 0.81; 95% CI: 0.68-0.97; P = 0.02). Among patients with LVEF >50%, residual MR was ≤ mild in 76.0% and moderate in 19.0%. Compared with ≤ mild MR, moderate residual MR was associated with increased 1-year risks of death (adjusted HR: 1.46; 95% CI: 1.01-2.10; P = 0.04) and heart failure hospitalization (adjusted HR: 1.82; 95% CI: 1.32-2.52; P < 0.001). At 1 year, the KCCQ score improved in patients with LVEF >50% treated with MTEER (residual MR grade ≤ mild, 28.7 ± 26.8; moderate MR, 25.7 ± 27.2; > moderate MR, 21.6 ± 12.0; all P < 0.05).
Conclusions: In patients with sMR and preserved LVEF, MTEER was associated with a high rate of technical success, a low rate of complications, and large improvements in health status.
Competing Interests: Funding Support and Author Disclosures This research was supported by the ACC/STS TVT Registry. The views expressed in this manuscript represent those of the author(s), and do not necessarily represent the official views of the registry or its associated professional societies identified at CVQuality.ACC.org/NCDR. Dr Huded has received consulting fees from Medtronic and Boston Scientific. Dr Chhatriwalla has received consulting fees from Edwards Lifesciences and Medtronic Inc; and has received institutional research support from Boston Scientific. Dr Vemulapalli has received grants/contracts from Abbott Vascular, Cytokinetics, National Institutes of Health (R01 and UG3), Edwards Lifesciences, American College of Cardiology, and Society of Thoracic Surgeons; and has received consulting/advisory fees from Veralox Therapeutics, Medtronic, AstraZeneca, Boehringer–Ingelheim, American College of Physicians, and Total CME. Dr Kosinski has received grants from the American College of Cardiology and Society of Thoracic Surgeons. Dr Cohen has received institutional research grant support from Edwards Lifesciences, Abbott, and Boston Scientific; and has received consulting fees from Edwards Lifesciences, Abbott, and Medtronic. Ms Shah has reported that she has no relationships relevant to the contents of this paper to disclose
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