Impact of effective regurgitant orifice area on outcome of secondary mitral regurgitation transcatheter repair
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Impact of effective regurgitant orifice area on outcome of secondary mitral regurgitation transcatheter repair. / Karam, Nicole; Orban, Mathias; Kalbacher, Daniel; Butter, Christian; Praz, Fabien; Lubos, Edith; Bannehr, Marwin; Kassar, Mohammad; Petrescu, Aniela; Iliadis, Christos; Unterhuber, Matthias; Asselin, Anouk; Thiele, Holger; Pfister, Roman; Windecker, Stephan; Lurz, Philipp; von Bardeleben, Stephan; Hausleiter, Jörg; EuroSMR Investigators.
in: CLIN RES CARDIOL, Jahrgang 110, Nr. 5, 05.2021, S. 732-739.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Impact of effective regurgitant orifice area on outcome of secondary mitral regurgitation transcatheter repair
AU - Karam, Nicole
AU - Orban, Mathias
AU - Kalbacher, Daniel
AU - Butter, Christian
AU - Praz, Fabien
AU - Lubos, Edith
AU - Bannehr, Marwin
AU - Kassar, Mohammad
AU - Petrescu, Aniela
AU - Iliadis, Christos
AU - Unterhuber, Matthias
AU - Asselin, Anouk
AU - Thiele, Holger
AU - Pfister, Roman
AU - Windecker, Stephan
AU - Lurz, Philipp
AU - von Bardeleben, Stephan
AU - Hausleiter, Jörg
AU - EuroSMR Investigators
PY - 2021/5
Y1 - 2021/5
N2 - OBJECTIVES: To assess the value of effective regurgitant orifice (ERO) in predicting outcome after edge-to-edge transcatheter mitral valve repair (TMVR) for secondary mitral regurgitation (SMR) and identify the optimal cut-off for patients' selection.METHODS: Using the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry, that included patients undergoing edge-to-edge TMVR for SMR between November 2008 and January 2019 in 8 experienced European centres, we assessed the optimal ERO threshold associated with mortality in SMR patients undergoing TMVR, and compared characteristics and outcomes of patients according to baseline ERO.RESULTS: Among 1062 patients with severe SMR and ERO quantification by proximal isovelocity surface area method in the registry, ERO was < 0.3 cm2 in 575 patients (54.1%), who were more symptomatic at baseline (NYHA class ≥ III: 91.4% vs. 86.9%, for ERO < vs. ≥ 0.3 cm2; P = 0.004). There was no difference in all-cause mortality at 2-year follow-up according to baseline ERO (28.3% vs. 30.0% for ERO < vs. ≥ 0.3 cm2, P = 0.585). Both patient groups demonstrated significant improvement of at least one NYHA class (61.7% and 73.8%, P = 0.002), resulting in a prevalence of NYHA class ≤ II at 1-year follow-up of 60.0% and 67.4% for ERO < vs. ≥ 0.3 cm2, respectively (P = 0.05).CONCLUSION: All-cause mortality at 2 years after TMVR does not differ if baseline ERO is < or ≥ 0.3 cm2, and both groups exhibit relevant clinical improvements. Accordingly, TMVR should not be withheld from patients with ERO < 0.3 cm2 who remain symptomatic despite optimal medical treatment, if TMVR appropriateness was determined by experienced teams in dedicated valve centres.
AB - OBJECTIVES: To assess the value of effective regurgitant orifice (ERO) in predicting outcome after edge-to-edge transcatheter mitral valve repair (TMVR) for secondary mitral regurgitation (SMR) and identify the optimal cut-off for patients' selection.METHODS: Using the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry, that included patients undergoing edge-to-edge TMVR for SMR between November 2008 and January 2019 in 8 experienced European centres, we assessed the optimal ERO threshold associated with mortality in SMR patients undergoing TMVR, and compared characteristics and outcomes of patients according to baseline ERO.RESULTS: Among 1062 patients with severe SMR and ERO quantification by proximal isovelocity surface area method in the registry, ERO was < 0.3 cm2 in 575 patients (54.1%), who were more symptomatic at baseline (NYHA class ≥ III: 91.4% vs. 86.9%, for ERO < vs. ≥ 0.3 cm2; P = 0.004). There was no difference in all-cause mortality at 2-year follow-up according to baseline ERO (28.3% vs. 30.0% for ERO < vs. ≥ 0.3 cm2, P = 0.585). Both patient groups demonstrated significant improvement of at least one NYHA class (61.7% and 73.8%, P = 0.002), resulting in a prevalence of NYHA class ≤ II at 1-year follow-up of 60.0% and 67.4% for ERO < vs. ≥ 0.3 cm2, respectively (P = 0.05).CONCLUSION: All-cause mortality at 2 years after TMVR does not differ if baseline ERO is < or ≥ 0.3 cm2, and both groups exhibit relevant clinical improvements. Accordingly, TMVR should not be withheld from patients with ERO < 0.3 cm2 who remain symptomatic despite optimal medical treatment, if TMVR appropriateness was determined by experienced teams in dedicated valve centres.
KW - Aged
KW - Aged, 80 and over
KW - Cardiac Catheterization/methods
KW - Cohort Studies
KW - Female
KW - Follow-Up Studies
KW - Heart Valve Prosthesis Implantation/methods
KW - Humans
KW - Male
KW - Mitral Valve Insufficiency/surgery
KW - Mortality
KW - Patient Selection
KW - Prognosis
KW - Registries
KW - Retrospective Studies
KW - Severity of Illness Index
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1007/s00392-021-01807-0
DO - 10.1007/s00392-021-01807-0
M3 - SCORING: Journal article
C2 - 33661372
VL - 110
SP - 732
EP - 739
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 5
ER -
