Impact of Intraprocedural Mitral Regurgitation and Gradient Following Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation - Université de Picardie Jules Verne Accéder directement au contenu
Article Dans Une Revue JACC: Cardiovascular Interventions Année : 2024

Impact of Intraprocedural Mitral Regurgitation and Gradient Following Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation

Sebastian Ludwig
Benedikt Koell
Jessica Weimann
  • Fonction : Auteur
Dhairya Patel
  • Fonction : Auteur
Lukas Stolz
Tetsu Tanaka
Teresa Trenkwalder
Felix Rudolph
Daryoush Samim
Philipp von Stein
Cristina Giannini
  • Fonction : Auteur
Julien Dreyfus
Jean-Michel Paradis
  • Fonction : Auteur
Bruno Melica
  • Fonction : Auteur
Angelo Quagliana
Yoan Lavie Badie
  • Fonction : Auteur
Mirjam Kessler
  • Fonction : Auteur
Omar Chehab
Simon Redwood
Edith Lubos
  • Fonction : Auteur
Lars Søndergaard
  • Fonction : Auteur
Marco Metra
Chiara Primerano
  • Fonction : Auteur
Christos Iliadis
Fabien Praz
  • Fonction : Auteur
Muhammed Gerçek
  • Fonction : Auteur
Erion Xhepa
Georg Nickenig
  • Fonction : Auteur
Azeem Latib
Niklas Schofer
  • Fonction : Auteur
Raj Makkar
  • Fonction : Auteur
Juan Granada
  • Fonction : Auteur
Thomas Modine
Jörg Hausleiter
  • Fonction : Auteur
Daniel Kalbacher
Augustin Coisne

Résumé

Background: The impact of intraprocedural results following transcatheter edge-to-edge repair (TEER) in primary mitral regurgitation (MR) is controversial. Objectives: This study sought to investigate the prognostic impact of intraprocedural residual mitral regurgitation (rMR) and mean mitral valve gradient (MPG) in patients with primary MR undergoing TEER. Methods: The PRIME-MR (Outcomes of Patients Treated With Mitral Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation) registry included consecutive patients with primary MR undergoing TEER from 2008 to 2022 at 27 international sites. Clinical outcomes were assessed according to intraprocedural rMR and mean MPG. Patients were categorized according to rMR (optimal result: ≤1+, suboptimal result: ≥2+) and MPG (low gradient: ≤5 mm Hg, high gradient: > 5 mm Hg). The prognostic impact of rMR and MPG was evaluated in a Cox regression analysis. The primary endpoint was 2-year all-cause mortality or heart failure hospitalization. Results: Intraprocedural rMR and mean MPG were available in 1,509 patients (median age = 82 years [Q1-Q3: 76.0-86.0 years], 55.1% male). Kaplan-Meier analysis according to rMR severity showed significant differences for the primary endpoint between rMR ≤1+ (29.1%), 2+ (41.7%), and ≥3+ (58.0%; P < 0.001), whereas there was no difference between patients with a low (32.4%) and high gradient (42.1%; P = 0.12). An optimal result/low gradient was achieved in most patients (n = 1,039). The worst outcomes were observed in patients with a suboptimal result/high gradient. After adjustment, rMR ≥2+ was independently linked to the primary endpoint (HR: 1.87; 95% CI: 1.32-2.65; P < 0.001), whereas MPG >5 mm Hg was not (HR: 0.78; 95% CI: 0.47-1.31; P = 0.35). Conclusions: Intraprocedural rMR but not MPG independently predicted clinical outcomes following TEER for primary MR. When performing TEER in primary MR, optimal MR reduction seems to outweigh the impact of high transvalvular gradients.
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Dates et versions

hal-04645829 , version 1 (12-07-2024)

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Citer

Sebastian Ludwig, Benedikt Koell, Jessica Weimann, Erwan Donal, Dhairya Patel, et al.. Impact of Intraprocedural Mitral Regurgitation and Gradient Following Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation. JACC: Cardiovascular Interventions, 2024, 17 (13), pp.1559-1573. ⟨10.1016/j.jcin.2024.05.018⟩. ⟨hal-04645829⟩
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