Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation,JACC: Cardiovascular Imaging

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Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation
JACC: Cardiovascular Imaging ( IF 14.0 ) Pub Date : 2022-07-13 , DOI: 10.1016/j.jcmg.2022.05.009
Philipp Doldi ₁ , Lukas Stolz ₂ , Mathias Orban ₁ , Nicole Karam ₃ , Fabien Praz ₄ , Daniel Kalbacher ₅ , Edith Lubos ₅ , Daniel Braun ₁ , Marianna Adamo ₆ , Cristina Giannini ₇ , Bruno Melica ₈ , Michael Näbauer ₂ , Satoshi Higuchi ₂ , Mirjam Wild ₂ , Michael Neuss ₆ , Christian Butter ₉ , Mohammad Kassar ₄ , Aniela Petrescu ₁₀ , Roman Pfister ₁₁ , Christos Iliadis ₁₁ , Matthias Unterhuber ₁₂ , Holger Thiele ₁₂ , Stephan Baldus ₁₁ , Ralph Stephan von Bardeleben ₁₀ , Niklas Schofer ₁₃ , Christian Hagl ₁₄ , Anna Sonia Petronio ₇ , Steffen Massberg ₁ , Stephan Windecker ₄ , Philipp Lurz ₁₂ , Marco Metra ₆ , Jörg Hausleiter ₁

Affiliation

Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.
Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.
Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France.
Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland.
Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany.
Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy.
Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal.
Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany.
Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany.
Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany.
Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany.
Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany.

Background

Among patients with severe functional mitral regurgitation (FMR), atrial functional mitral regurgitation (aFMR) represents an underrecognized entity. Data regarding outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) in aFMR remain scarce.

Objectives

The objective of this study was to analyze the outcome of aFMR patients undergoing M-TEER.

Methods

Using patients from the international EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry undergoing M-TEER for FMR, the authors analyzed baseline characteristics and 2-year outcomes in aFMR in comparison to non-aFMR and ventricular FMR. Additionally, the impact of right ventricular dysfunction (RVD) (defined as right ventricular to pulmonary artery uncoupling) on outcome after M-TEER was assessed.

Results

Among 1,608 FMR patients treated by M-TEER, 126 (7.8%) were categorized as aFMR. All 126 aFMR patients had preserved left ventricular function without regional wall motion abnormalities, left arterial dilatation and Carpentier leaflet motion type I. Procedural success (defined as mitral regurgitation ≤2+ at discharge) was 87.2% (P < 0.001) and New York Heart Association (NYHA) functional class significantly improved during follow-up (NYHA functional class III/IV: 86.5% at baseline to 36.6% at follow-up; P < 0.001). The estimated 2-year survival rate in aFMR patients was 70.4%. Two-year survival did not differ significantly between aFMR, non-aFMR, and ventricular FMR. Besides NYHA functional class IV, RVD was identified as a strong independent predictor for 2-year survival (HR: 2.82 [95% CI: 1.24-6.45]; P = 0.014).

Conclusions

aFMR is a frequent cause of FMR and can be effectively treated with M-TEER to improve symptoms at follow-up. Advanced heart failure symptoms and RVD were identified as important risk factors for survival in aFMR patients.

中文翻译：

心房功能性二尖瓣反流患者的经导管二尖瓣修复术

背景

在患有严重功能性二尖瓣反流 (FMR) 的患者中，心房功能性二尖瓣反流 (aFMR) 是一个未被充分认识的实体。关于 aFMR 中二尖瓣经导管边缘到边缘修复 (M-TEER) 后结果的数据仍然很少。

目标

本研究的目的是分析接受 M-TEER 的 aFMR 患者的结果。

方法

使用来自国际 EuroSMR（欧洲继发性二尖瓣反流经导管修复登记处）登记处接受 M-TEER 治疗 FMR 的患者，作者分析了 aFMR 与非 aFMR 和心室 FMR 的基线特征和 2 年结果。此外，评估了 M-TEER 后右心室功能障碍 (RVD)（定义为右心室与肺动脉解偶联）对结果的影响。

结果

在接受 M-TEER 治疗的 1,608 名 FMR 患者中，126 名 (7.8%) 被归类为 aFMR。所有 126 名 aFMR 患者均保留了左心室功能，没有局部室壁运动异常、左动脉扩张和 Carpentier 小叶运动 I 型。手术成功率（定义为出院时二尖瓣反流≤2+）为 87.2% ( P < 0.001) 和 New York Heart协会 (NYHA) 功能分级在随访期间显着改善（NYHA 功能分级 III/IV：基线时为 86.5%，随访时为 36.6%；P <0.001）。aFMR 患者的估计 2 年生存率为 70.4%。两年生存率在 aFMR、非 aFMR 和心室 FMR 之间没有显着差异。除了 NYHA 功能分级 IV 之外，RVD 被确定为 2 年生存率的一个强有力的独立预测因子（HR：2.82 [95% CI：1.24-6.45]；P = 0.014）。