One-Year Outcomes According to Mitral Regurgitation Etiology Following Transcatheter Edge-to-Edge Repair With the PASCAL System: Results From a Multicenter Registry

Transcatheter edge-to-edge repair in anatomically complex degenerative mitral regurgitation: 3-year outcomes from a real-world registry

BACKGROUND

Recent developments in transcatheter mitral valve repair (M-TEER) have expanded the indication for the procedure beyond conventional criteria to include patients with anatomically complex degenerative mitral regurgitation (DMR), but long-term outcomes are not well known.

AIMS

To investigate outcomes by specific anatomical criteria in patients with severe DMR and complex valve anatomy enrolled in the prospective MitraUlm registry.

METHODS

Clinical and echocardiographic 3-year outcomes of 304 patients with DMR and complex mitral valve anatomy, defined according to the CLASP IID registry criteria, were investigated. Outcomes were analysed separately for specific anatomical complexities.

RESULTS

33.5% of patients had ≥ independent significant jets, 12% multisegmental prolapse, 12.3% mitral valve orifice area < 4 cm2, 10.9% commissural lesions with wide/multiple jets, and 10.1% large flail. Mitral regurgitation (MR) reduction ≤ 2 was achieved in 93.8% of patients at discharge and in 85.9% at 3-year follow-up. Patients with multisegmental prolapse and commissural lesions with multiple/wide jets had the lowest MR reduction at discharge. Compared to patients treated with MitraClip Generation 1-3, patients treated with MitraClip Generation 4 had significantly better post-procedural MR reduction (MR ≤ 1 in 74.3% vs 50.7%, P < 0.001) and higher 3-year survival rates (80.2% vs 61.6%, Log Rank P = 0.002). Postprocedural MR reduction to MR ≤ 1 was the strongest independent predictor of 3-year survival, whereas the presence of at least two anatomical complexities and elevated post-procedural left atrial pressure predicted 3-year all-cause mortality.

CONCLUSIONS

In patients with anatomically complex DMR, advances in procedural techniques for M-TEER have allowed successful treatment with sustained MR reduction and improved long-term survival.

Registries on transcatheter edge-to-edge repair in heart failure: Current evidence and future perspectives

AIMS

Secondary mitral regurgitation (SMR) and tricuspid regurgitation (TR) are the most common valvular heart diseases in patients with heart failure (HF). Transcatheter edge-to-edge repair (TEER) devices designed for treating MR and TR have been successfully tested in randomized controlled trials, but methodological issues have often challenged their interpretation. This manuscript aimed to provide an overview of TEER registries on SMR and TR in HF, highlighting their key features, describing clinical characteristics and outcomes of patients receiving these devices, and exploring the available data limitations.

METHODS AND RESULTS

PubMed, Web of Science, and EMBASE were searched for registries reporting on TEER in SMR or TR. Registries were excluded if single-centre and with <100 patients. Twenty-six registries (46% prospective, 12% ongoing), including a total cohort of 18 925 patients, were retrieved for TEER in SMR, and six registries (50% retrospective, 33% ongoing) reported on the use of TEER for TR in a total cohort of 1412 patients. Limited geographical representativity outside North America and Europe, high number of missing values, and inconsistency in data reporting were the main existing evidence limitations.

CONCLUSION

Registries on TEER represent a key data source in a setting where it is difficult to conduct randomized controlled trials. However, limitations in design, patient characterization, and outcomes reporting restrain their use. A novel conceptual framework for future prospective TEER registries, as proposed in this document, might inform current practice, address relevant clinical questions and future trial design.