Long-Term Outcomes of Patients With Elevated Mitral Valve Pressure Gradient After Mitral Valve Edge-to-Edge Repair
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Long-Term Outcomes of Patients With Elevated Mitral Valve Pressure Gradient After Mitral Valve Edge-to-Edge Repair. / Koell, Benedikt; Ludwig, Sebastian; Weimann, Jessica; Waldschmidt, Lara; Hildebrandt, Annabel; Schofer, Niklas; Schirmer, Johannes; Westermann, Dirk; Reichenspurner, Hermann; Blankenberg, Stefan; Conradi, Lenard; Lubos, Edith; Kalbacher, Daniel.
In: JACC-CARDIOVASC INTE, Vol. 15, No. 9, 09.05.2022, p. 922-934.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Long-Term Outcomes of Patients With Elevated Mitral Valve Pressure Gradient After Mitral Valve Edge-to-Edge Repair
AU - Koell, Benedikt
AU - Ludwig, Sebastian
AU - Weimann, Jessica
AU - Waldschmidt, Lara
AU - Hildebrandt, Annabel
AU - Schofer, Niklas
AU - Schirmer, Johannes
AU - Westermann, Dirk
AU - Reichenspurner, Hermann
AU - Blankenberg, Stefan
AU - Conradi, Lenard
AU - Lubos, Edith
AU - Kalbacher, Daniel
N1 - Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2022/5/9
Y1 - 2022/5/9
N2 - OBJECTIVES: The aim of this study was to investigate the adverse impact of elevated postprocedural mitral valve pressure gradient (MPG) on outcome in a real-world population of patients with severe mitral regurgitation (MR) who underwent transcatheter mitral valve edge-to-edge repair (TEER).BACKGROUND: TEER has become a routine treatment alternative for patients with severe MR at high surgical risk. The consequences of elevated MPG after TEER have been subject to controversial debates.METHODS: All consecutive patients undergoing TEER for either severe degenerative MR (DMR) or functional MR (FMR) at a high-volume center between September 2008 and January 2020 were prospectively included and followed periodically. Postprocedural MPG by discharge transthoracic echocardiography was considered elevated at ≥5 mm Hg. The primary combined endpoint was death or heart failure rehospitalization after 5 years.RESULTS: A total of 713 patients undergoing TEER (DMR, n = 265; FMR, n = 445) were included. Elevated postprocedural MPG was present in 37.0% of those with DMR (n = 98) and 22.0% of those with FMR (n = 98). In contrast to patients with FMR, 6-minute walk distance did not improve in patients with DMR with elevated MPG. Kaplan-Meier analyses did not demonstrate significant differences for the primary endpoint in patients with DMR (low vs elevated MPG, 67.3% vs 74.4%; P = 0.06) and those with FMR (78.6% vs 74.8%; P = 0.54). After adjustment, elevated MPG was an independent predictor of the primary endpoint in patients with DMR (HR: 1.59; 95% CI: 1.03-2.45; P = 0.034) but not in those with FMR (HR: 0.87; 95% CI: 0.63-1.22; P = 0.43).CONCLUSIONS: Elevated postprocedural MPG is an independent predictor of adverse clinical and functional outcomes in patients with DMR but not in those with FMR.
AB - OBJECTIVES: The aim of this study was to investigate the adverse impact of elevated postprocedural mitral valve pressure gradient (MPG) on outcome in a real-world population of patients with severe mitral regurgitation (MR) who underwent transcatheter mitral valve edge-to-edge repair (TEER).BACKGROUND: TEER has become a routine treatment alternative for patients with severe MR at high surgical risk. The consequences of elevated MPG after TEER have been subject to controversial debates.METHODS: All consecutive patients undergoing TEER for either severe degenerative MR (DMR) or functional MR (FMR) at a high-volume center between September 2008 and January 2020 were prospectively included and followed periodically. Postprocedural MPG by discharge transthoracic echocardiography was considered elevated at ≥5 mm Hg. The primary combined endpoint was death or heart failure rehospitalization after 5 years.RESULTS: A total of 713 patients undergoing TEER (DMR, n = 265; FMR, n = 445) were included. Elevated postprocedural MPG was present in 37.0% of those with DMR (n = 98) and 22.0% of those with FMR (n = 98). In contrast to patients with FMR, 6-minute walk distance did not improve in patients with DMR with elevated MPG. Kaplan-Meier analyses did not demonstrate significant differences for the primary endpoint in patients with DMR (low vs elevated MPG, 67.3% vs 74.4%; P = 0.06) and those with FMR (78.6% vs 74.8%; P = 0.54). After adjustment, elevated MPG was an independent predictor of the primary endpoint in patients with DMR (HR: 1.59; 95% CI: 1.03-2.45; P = 0.034) but not in those with FMR (HR: 0.87; 95% CI: 0.63-1.22; P = 0.43).CONCLUSIONS: Elevated postprocedural MPG is an independent predictor of adverse clinical and functional outcomes in patients with DMR but not in those with FMR.
KW - Cardiac Surgical Procedures
KW - Echocardiography
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Humans
KW - Mitral Valve/diagnostic imaging
KW - Mitral Valve Insufficiency/diagnostic imaging
KW - Treatment Outcome
U2 - 10.1016/j.jcin.2021.12.007
DO - 10.1016/j.jcin.2021.12.007
M3 - SCORING: Journal article
C2 - 35512916
VL - 15
SP - 922
EP - 934
JO - JACC-CARDIOVASC INTE
JF - JACC-CARDIOVASC INTE
SN - 1936-8798
IS - 9
ER -
