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Right ventricular dysfunction predicts outcome after transcatheter mitral valve repair for primary mitral valve regurgitation. 2022
Philipp M Doldi, and
Lukas Stolz, and
Daniel Kalbacher, and
Benedikt Köll, and
Martin Geyer, and
Sebastian Ludwig, and
Mathias Orban, and
Daniel Braun, and
Ludwig T Weckbach, and
Thomas J Stocker, and
Michael Näbauer, and
Satoshi Higuchi, and
Tobias Ruf, and
Jaqueline Da Rocha E Silva, and
Mirjam Wild, and
Noemie Tence, and
Matthias Unterhuber, and
Niklas Schofer, and
Aniela Petrescu, and
Holger Thiele, and
Philipp Lurz, and
Edith Lubos, and
Stephan von Bardeleben, and
Nicole Karam, and
Daryoush Samim, and
Jean-Michel Paradis, and
Christos Iliadis, and
Erion Xhepa, and
Christian Hagl, and
Steffen Massberg, and
Jörg Hausleiter, and
Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.
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. 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). 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.
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