Background:Although transcatheter edge-to-edge repair (TEER) is effective and safe, there is a need for better prediction of optimal outcomes. We aimed to determine predictors of optimal reduction in mitral regurgitation (MR) and survival with TEER.Methods:We examined mitral anatomy and its change with TEER on outcomes in 183 patients (age, 82 [77–87] years; 53% women). Coaptation reserve was measured as the distance of continuous apposition of the A2 and P2 leaflet segments in 2-dimensional apical long-axis imaging at the site of the predominant jet of MR. Augmentation in coaptation was measured as the total amount of leaflet insertion. Addressable coaptation area was calculated using the physical boundaries of the TEER device.Results:Coaptation reserve, its augmentation, and addressable coaptation area were strong predictors of MR reduction (all P<0.001), as well as heart failure hospitalization and death. For patients with either mild or no residual MR, median values for coaptation reserve, its augmentation, and addressable coaptation area were 3.7 (2.8–4.5) mm, 7.3 (5.2–9.5) mm, and 59.0 (48.0–71.8) mm², respectively. Receiver operating characteristic analyses determined the best values for optimal MR reduction as a coaptation reserve of >3.0 mm (P<0.001), addressable coaptation area of ≥52 mm² (P<0.001), and coaptation augmentation of ≥4.7 mm (P<0.001). These values were associated with greater 2-year survival free of all-cause mortality and persisting even in analyses restricted to those with mild or no residual MR after TEER.Conclusions:Coaptation reserve and its augmentation are simple, independent parameters that predict optimal MR reduction and better survival in patients undergoing TEER. These findings may have implications for patient selection and expanded use of the therapy.

中文翻译：

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接合储备预测二尖瓣反流的最佳减少和经导管边缘到边缘修复的长期生存

背景：尽管经导管边缘到边缘修复 (TEER) 是有效且安全的，但仍需要更好地预测最佳结果。我们的目的是确定 TEER 最佳减少二尖瓣反流 (MR) 和生存率的预测因子。方法：我们检查了 TEER 对 183 名患者（年龄 82 [77-87] 岁；53% 女性）结果的二尖瓣解剖结构及其变化. 接合储备被测量为在 MR 主要射流部位的二维顶端长轴成像中 A2 和 P2 瓣叶段的连续并置距离。接合的增强被测量为小叶插入的总量。使用 TEER 设备的物理边界计算可寻址接合区域。结果：接合储备、其增加和可寻址接合区域是 MR 减少的强预测因子（所有P <0.001），以及心力衰竭住院和死亡。对于轻度或无残留 MR 的患者，接合储备、其增强和可寻址接合面积的中值分别为 3.7 (2.8–4.5) mm、7.3 (5.2–9.5) mm 和 59.0 (48.0–71.8) mm ²，分别。接受者操作特征分析确定了最佳 MR 减少的最佳值，因为接合储备>3.0 mm ( P <0.001)，可寻址接合面积≥52 mm ² ( P <0.001)，接合增强≥4.7 mm ( P<0.001)。这些值与更高的 2 年无全因死亡率的生存率相关，并且即使在仅限于 TEER 后轻度或无残留 MR 的分析中也持续存在。结论：接合储备及其增加是预测最佳 MR 减少的简单、独立的参数接受 TEER 的患者的生存率更高。这些发现可能对患者的选择和治疗的扩大使用产生影响。