Right ventricular dysfunction predicts outcome after transcatheter mitral valve repair for primary mitral valve regurgitation

Doldi, Philipp M. ; Stolz, Lukas; Kalbacher, Daniel; Köll, Benedikt; Geyer, Martin; Ludwig, Sebastian; Orban, Mathias; Braun, Daniel; Weckbach, Ludwig T.; Stocker, Thomas; Näbauer, Michael; Higuchi, Satoshi; Ruf, Tobias; Rocha e Silva, Jaqueline da; Wild, Mirjam; Tence, Noemie; Unterhuber, Matthias; Schofer, Niklas; Petrescu, Aniela; Thiele, Holger; Lurz, Philipp; Lubos, Edith; Bardeleben, Stephan von; Karam, Nicole; Samim, Daryoush; Paradis, Jean-Michel; Iliadis, Christos; Xhepa, Erion; Hagl, Christian; Massberg, Steffen und Hausleiter, Jörg (2022): Right ventricular dysfunction predicts outcome after transcatheter mitral valve repair for primary mitral valve regurgitation. In: European Journal of Heart Failure, Bd. 24, Nr. 11: S. 2162-2171

Abstract

Aims Right ventricular dysfunction (RVD), as expressed by right ventricular to pulmonary artery coupling, has recently been identified as a strong outcome predictor in patients undergoing mitral valve edge-to-edge repair (M-TEER) for secondary mitral regurgitation (MR). The aim of this study was to define RVD in patients undergoing M-TEER for primary MR (PMR) and to evaluate its impact on procedural MR reduction, symptomatic development and 2-year all-cause mortality. Methods and results This multicentre study included patients undergoing M-TEER for symptomatic PMR at nine international centres. The study cohort was divided into a derivation (DC) and validation cohort (VC) for calculation and validation of the best discriminatory value for RVD. A total of 648 PMR patients were included in the study. DC and VC were comparable regarding procedural success and outcomes at follow-up. Sensitivity analysis identified RVD as an independent predictor for 2-year mortality in the DC (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.47- 3.81, p < 0.001), which was confirmed in the VC (HR 2.06, 95% CI 1.36-3.13, p < 0.001). Procedural success (MR <= 2+) and symptomatic improvement at follow-up (New York Heart Association [NYHA] class <= II) were lower in PMR patients with RVD (MR <= 2+: 82% vs. 93%, p = 0.002;NYHA class <= II: 57.3% vs. 66.5%, p = 0.09 for with vs. without RVD). In all PMR patients, the presence of RVD significantly impaired 2-year survival after M-TEER (HR 2.23, 95% CI 1.63-3.05, p < 0.001). Conclusions Mitral valve edge-to-edge repair is an effective treatment option for PMR patients. The presence of RVD is associated with less MR reduction, less symptomatic improvement and increased 2-year mortality. Accordingly, RVD might be included into pre-procedural prognostic considerations. [GRAPHICS] .

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1388-9842
• Sprache: Englisch
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892