Aim To evaluate short-term changes in tricuspid regurgitation (TR) after transcatheter edge-to-edge mitral valve repair (M-TEER) in secondary mitral regurgitation (SMR), their predictors and impact on mortality. Methods and results This is a retrospective analysis of SMR patients undergoing successful M-TEER (post-procedural mitral regurgitation <= 2+) at 13 European centres. Among 503 patients evaluated 79 (interquartile range [IQR] 40-152) days after M-TEER, 173 (35%) showed >= 1 degree of TR improvement, 97 (19%) had worsening of TR, and 233 (46%) remained unchanged. Smaller baseline left atrial diameter and residual mitral regurgitation 0/1+ were independent predictors of TR <= 2+ after M-TEER. There was a significant association between TR changes and New York Heart Association class and pulmonary artery systolic pressure decrease at echocardiographic re-assessment. At a median follow-up of 590 (IQR 209-1103) days from short-term echocardiographic re-assessment, all-cause mortality was lower in patients with improved compared to those with unchanged/worsened TR (29.6% vs. 42.3% at 3 years; log-rank p = 0.034). Baseline TR severity was not associated with mortality, whereas TR 0/1+ and 2+ at short-term follow-up was associated with lower all-cause mortality compared to TR 3/4+ (30.6% and 35.6% vs. 55.6% at 3 years; p < 0.001). A TR <= 2+ after M-TEER was independently associated with a 42% decreased risk of mortality (p = 0.011). Conclusion More than one third of patients with SMR undergoing successful M-TEER experienced an improvement in TR. Pre-procedural TR was not associated with outcome, but a TR <= 2+ at short-term follow-up was independently associated with long-term mortality. Optimal M-TEER result and a small left atrium were associated with a higher likelihood of TR <= 2+ after M-TEER.

Evolution of tricuspid regurgitation after transcatheter edge-to-edge mitral valve repair for secondary mitral regurgitation and its impact on mortality / Adamo, Marianna; Pagnesi, Matteo; Ghizzoni, Giulia; Estévez-Loureiro, Rodrigo; Raposeiras-Roubin, Sergio; Tomasoni, Daniela; Stolfo, Davide; Sinagra, Gianfranco; Popolo Rubbio, Antonio; Bedogni, Francesco; De Marco, Federico; Giannini, Cristina; Petronio, Anna Sonia; Stazzoni, Laura; Benito-González, Tomás; Fernández-Vázquez, Felipe; Garrote-Coloma, Carmen; Godino, Cosmo; Agricola, Eustachio; Munafò, Andrea; Pascual, Isaac; Avanzas, Pablo; Léon, Victor; Montefusco, Antonio; Boretto, Paolo; Pidello, Stefano; Moñivas-Palomero, Vanessa; Del Trigo, Maria; Biagini, Elena; Berardini, Alessandra; Saia, Francesco; Nombela-Franco, Luis; Tirado-Conte, Gabriela; De Augustin, Alberto; Caneiro-Queija, Berenice; De Luca, Antonio; Branca, Luca; Zaccone, Gregorio; Lupi, Laura; Lipsic, Erik; Voors, Adriaan; Metra, Marco. - In: EUROPEAN JOURNAL OF HEART FAILURE. - ISSN 1388-9842. - 24:11(2022), pp. 2175-2184. [10.1002/ejhf.2637]

Evolution of tricuspid regurgitation after transcatheter edge-to-edge mitral valve repair for secondary mitral regurgitation and its impact on mortality

Pagnesi, Matteo;Agricola, Eustachio;
2022-01-01

Abstract

Aim To evaluate short-term changes in tricuspid regurgitation (TR) after transcatheter edge-to-edge mitral valve repair (M-TEER) in secondary mitral regurgitation (SMR), their predictors and impact on mortality. Methods and results This is a retrospective analysis of SMR patients undergoing successful M-TEER (post-procedural mitral regurgitation <= 2+) at 13 European centres. Among 503 patients evaluated 79 (interquartile range [IQR] 40-152) days after M-TEER, 173 (35%) showed >= 1 degree of TR improvement, 97 (19%) had worsening of TR, and 233 (46%) remained unchanged. Smaller baseline left atrial diameter and residual mitral regurgitation 0/1+ were independent predictors of TR <= 2+ after M-TEER. There was a significant association between TR changes and New York Heart Association class and pulmonary artery systolic pressure decrease at echocardiographic re-assessment. At a median follow-up of 590 (IQR 209-1103) days from short-term echocardiographic re-assessment, all-cause mortality was lower in patients with improved compared to those with unchanged/worsened TR (29.6% vs. 42.3% at 3 years; log-rank p = 0.034). Baseline TR severity was not associated with mortality, whereas TR 0/1+ and 2+ at short-term follow-up was associated with lower all-cause mortality compared to TR 3/4+ (30.6% and 35.6% vs. 55.6% at 3 years; p < 0.001). A TR <= 2+ after M-TEER was independently associated with a 42% decreased risk of mortality (p = 0.011). Conclusion More than one third of patients with SMR undergoing successful M-TEER experienced an improvement in TR. Pre-procedural TR was not associated with outcome, but a TR <= 2+ at short-term follow-up was independently associated with long-term mortality. Optimal M-TEER result and a small left atrium were associated with a higher likelihood of TR <= 2+ after M-TEER.
2022
Mortality
Transcatheter edge-to-edge mitral valve repair
Tricuspid regurgitation
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/134952
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 14
  • ???jsp.display-item.citation.isi??? 14
social impact