Refereed journal article or data article (A1)
Prognostic Value of Increased Mitral Valve Gradient After Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation
List of Authors: Yoon Sung-Han, Makar Moody, Kar SIBL, Chakravarty Tarun, Oakley Luke, Sekhon Navjot, Koseki Keita, Enta Yusuke, Nakamura Mamoo, Hamilton Michele, Patel Jignesh K., Singh Siddharth, Skaf Sabah, Siegel Robert J., Bax Jeroen J., Makkar Raj R.
Publisher: Elsevier
Publication year: 2022
Journal: JACC: Cardiovascular Interventions
Journal name in source: JACC. Cardiovascular interventions
Volume number: 15
Issue number: 9
Start page: 935
End page: 945
ISSN: 1876-7605
eISSN: 1876-7605
DOI: http://dx.doi.org/10.1016/j.jcin.2022.01.281
URL: https://doi.org/10.1016/j.jcin.2022.01.281
Objectives
This study sought to evaluate the prognostic value of an increased mean mitral valve pressure gradient (MVG) in patients with primary mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER).
BackgroundConflicting data exist regarding impact of increased mean MVG on outcomes after TEER.
MethodsThis study included 419 patients with primary MR (mean age 80.6 ± 10.4 years; 40.6% female) who underwent TEER. Patients were divided into quartiles (Qs) based on discharge echocardiographic mean MVG. Primary outcome was the composite endpoint of all-cause mortality and heart failure hospitalization. Secondary outcomes included all-cause mortality and the secondary composite endpoint of all-cause mortality, heart failure hospitalization, and mitral valve reintervention.
ResultsThe median number of MitraClips used was 2 per patient. MR reduction ≤moderate was achieved in 407 (97.1%) patients. Mean MVG was 1.9 ± 0.3 mm Hg, 3.0 ± 0.1 mm Hg, 4.0 ± 0.1 mm Hg, and 6.0 ± 1.2 mm Hg in Q1, Q2, Q3, and Q4, respectively. There was no significant differences across quartiles in the primary outcome (15.4%, 19.6%, 22.0%, and 21.9% in Q1-Q4, respectively; P = 0.63), all-cause mortality (15.9% vs 18.6% vs 19.4% vs 17.1%, respectively; P = 0.91), and the secondary composite endpoint at 2 years (33.3% vs 29.5% vs 22.0% vs 31.6%, respectively; P = 0.37). After multivariate adjustment for baseline clinical and procedural variables, the mean MVG in Q4 compared with Q1 to Q3 was not independently associated with the primary outcome (HR: 1.22; 95% CI: 0.82-1.83; P = 0.33), all-cause mortality, and the secondary composite endpoint.
ConclusionsIncreased mean MVG was not independently associated with adverse events after TEER in patients with primary MR.