Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation

Philipp Doldi; Lukas Stolz; Mathias Orban; Nicole Karam; Fabien Praz; Daniel Kalbacher; Edith Lubos; Daniel Braun; Marianna Adamo; Cristina Giannini; Bruno Melica; Michael Näbauer; Satoshi Higuchi; Mirjam Wild; Michael Neuss; Christian Butter; Mohammad Kassar; Aniela Petrescu; Roman Pfister; Christos Iliadis; Matthias Unterhuber; Holger Thiele; Stephan Baldus; Ralph Stephan von Bardeleben; Niklas Schofer; Christian Hagl; Anna Sonia Petronio; Steffen Massberg; Stephan Windecker; Philipp Lurz; Marco Metra; Jörg Hausleiter

doi:10.1016/j.jcmg.2022.05.009

Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation

JACC Cardiovasc Imaging. 2022 Nov;15(11):1843-1851. doi: 10.1016/j.jcmg.2022.05.009. Epub 2022 Jul 13.

Authors

Philipp Doldi¹, Lukas Stolz², Mathias Orban¹, Nicole Karam³, Fabien Praz⁴, Daniel Kalbacher⁵, Edith Lubos⁵, Daniel Braun¹, Marianna Adamo⁶, Cristina Giannini⁷, Bruno Melica⁸, Michael Näbauer², Satoshi Higuchi², Mirjam Wild², Michael Neuss⁶, Christian Butter⁹, Mohammad Kassar⁴, Aniela Petrescu¹⁰, Roman Pfister¹¹, Christos Iliadis¹¹, Matthias Unterhuber¹², Holger Thiele¹², Stephan Baldus¹¹, Ralph Stephan von Bardeleben¹⁰, Niklas Schofer¹³, Christian Hagl¹⁴, Anna Sonia Petronio⁷, Steffen Massberg¹, Stephan Windecker⁴, Philipp Lurz¹², Marco Metra⁶, Jörg Hausleiter¹⁵

Affiliations

¹ Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.
² Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.
³ Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France.
⁴ Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland.
⁵ Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany.
⁶ 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.
⁷ Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy.
⁸ Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal.
⁹ Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany.
¹⁰ Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany.
¹¹ Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany.
¹² Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
¹³ Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany.
¹⁴ Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany.
¹⁵ Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany. Electronic address: joerg.hausleiter@med.uni-muenchen.de.

PMID: 35842361
DOI: 10.1016/j.jcmg.2022.05.009

Abstract

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.

Keywords: atrial functional mitral valve regurgitation; congestive heart failure; mitral valve transcatheter edge-to-edge valve repair; right ventricular dysfunction; secondary mitral valve regurgitation.

MeSH terms

Cardiac Surgical Procedures* / adverse effects
Heart Valve Prosthesis Implantation* / adverse effects
Humans
Mitral Valve / diagnostic imaging
Mitral Valve / surgery
Mitral Valve Insufficiency* / diagnostic imaging
Mitral Valve Insufficiency* / etiology
Mitral Valve Insufficiency* / surgery
Predictive Value of Tests
Treatment Outcome
Ventricular Dysfunction, Right*
Ventricular Function, Left