Data on the prognostic factors after mitral valve (MV) transcatheter edge-to-edge repair (TEER; MV-TEER) are limited. Pulsed-wave Doppler interrogation of pulmonary vein flow (PVF) is a convenient method to assess the hemodynamic burden of residual mitral regurgitation (MR), which could be of utility as a predictor of outcomes. Patients that underwent MV-TEER between May 2014 and December 2021 at our institution were evaluated. Pulmonary vein flow patterns post-MV-TEER were reviewed on the procedural transesophageal echocardiogram and classified as normal (systolic dominant or codominant) or abnormal (systolic blunting or reversal). The PVF pattern was correlated with all-cause mortality at follow-up. Two-hundred sixty-five patients had diagnostic PVF post-MV-TEER, with 73 (27.5%) categorized as normal and 192 (72.5%) categorized as abnormal. Patients with abnormal PVF morphology were more likely to have atrial fibrillation (70% vs 42%, < .001) and greater than moderate residual MR (16% vs 3%, = .01) and had higher mean left atrial pressure (18.1 ± 5.0 vs 15.9 ± 4.2 mm Hg, = .002) and left atrial V wave (26.6 ± 8.5 vs 21.4 ± 7.3 mm Hg, < .001) postprocedure. In multivariable analysis, abnormal PVF morphology post-MV-TEER was independently associated with mortality at follow-up (hazard ratio = 1.70; 95% CI, 1.06-2.74; = .03) after correction for end-stage renal disease, atrial fibrillation, and residual MR. Results were similar in subgroups of patients with moderate or less and those with mild or less residual MR. Pulmonary vein flow morphology is a simple and objective tool to assess MR severity immediately post-MV-TEER and offers important prognostic information to optimize procedural results. Additional studies are needed to determine whether patients with abnormal PVF pattern post-MV-TEER would benefit from more intensive goal-directed medical therapy postprocedure.

中文翻译：

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经导管二尖瓣边对边修复后的肺静脉血流形态作为生存的预测因子

有关二尖瓣 (MV) 经导管边缘修复术 (TEER；MV-TEER) 后预后因素的数据有限。肺静脉血流 (PVF) 的脉冲波多普勒询问是评估残余二尖瓣反流 (MR) 血流动力学负担的便捷方法，可作为结果的预测指标。我们对 2014 年 5 月至 2021 年 12 月期间在我们机构接受 MV-TEER 的患者进行了评估。通过程序性经食管超声心动图检查 MV-TEER 后的肺静脉血流模式，并将其分类为正常（收缩期主导或共主导）或异常（收缩期钝化或逆转）。 PVF 模式与随访时的全因死亡率相关。 265 名患者在 MV-TEER 后出现诊断性 PVF，其中 73 名 (27.5%) 被归类为正常，192 名 (72.5%) 被归类为异常。 PVF 形态异常的患者更有可能出现心房颤动 (70% vs 42%, < .001) 和大于中度残余 MR (16% vs 3%, = .01)，并且平均左心房压力较高 (18.1 ± 5.0 vs 15.9 ± 4.2 mm Hg, = .002) 和术后左心房 V 波 (26.6 ± 8.5 vs 21.4 ± 7.3 mm Hg, < .001)。在多变量分析中，MV-TEER 后的异常 PVF 形态与纠正终末期肾病、心房颤动后的随访死亡率独立相关（风险比 = 1.70；95% CI，1.06-2.74；= .03）和残余 MR。中度或以下残留 MR 患者亚组和轻度或较少残留 MR 患者亚组的结果相似。肺静脉血流形态是一种简单而客观的工具，可在 MV-TEER 后立即评估 MR 严重程度，并提供重要的预后信息以优化手术结果。需要进行更多研究来确定 MV-TEER 后 PVF 模式异常的患者是否会受益于术后更强化的目标导向药物治疗。