BACKGROUND
Tricuspid transcatheter edge-to-edge repair (T-TEER) is an effective treatment for severe tricuspid regurgitation (TR), but predictors of outcome and clinical benefit after T-TEER remain limited.
METHODS
In 144 patients with severe symptomatic TR undergoing T-TEER, left and right ventricular stroke work indices (LVSWI, RVSWI) were calculated from invasive hemodynamics by right heart catheterization. Patients were stratified by median values (LVSWI 27 cJ/m2, RVSWI 6 cJ/m2) into four subgroups. The primary endpoint was one-year all-cause mortality.
RESULTS
After T-TEER, all-cause mortality was 28%. Outcomes differed significantly across subgroups: LVSWI high, RVSWI high: 15%, LVSWI high, RVSWI low: 15%, LVSWI low, RVSWI high: 55%, and LVSWI low, RVSWI low: 31% (Kaplan-Meier, log-rank p = 0.00027). Patients with low LVSWI but high RVSWI had the poorest survival, characterized by elevated pulmonary artery pressures, pulmonary capillary wedge pressure, and left ventricular transmural pressure. In univariate Cox regression, LVSWI below the median predicted mortality (≤ 27 cJ/m2; HR 4.73, 95% CI 2.07-10.8; p < 0.001), whereas RVSWI did not. LVSWI remained an independent predictor after adjusting in multivariate analysis (HR 0.44, 95% CI 0.27-0.71; p < 0.001).
CONCLUSION
LVSWI is a robust, independent prognostic marker after T-TEER, whereas RVSWI alone lacks predictive value. A discordant profile of low LVSWI with high RVSWI identifies a particularly high-risk subgroup with >50% mortality within one year. Incorporating stroke work indices into pre-procedural assessment may refine risk stratification and optimize management strategies in T-TEER candidates.
U. Hanses, Kathrin Diehl, Shiyar Alo et al.· Canadian Journal of Cardiolo...· 0 citations
BACKGROUND
Studies on mitral transcatheter edge-to-edge repair for atrial functional mitral regurgitation (AFMR) and ventricular functional mitral regurgitation (VFMR) are limited.
METHODS
We report 1-year outcomes of mitral transcatheter edge-to-edge repair for AFMR and VFMR using the PASCAL transcatheter valve repair system in the MiCLASP multicenter European postmarket clinical follow-up study (REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04430075).
RESULTS
Analysis included 295 patients with functional mitral regurgitation (75.5±9.93 years old, 59.3% male) from the first 600 enrolled in the MiCLASP study, with AFMR in 17.6% (52) and VFMR in 82.4% (243). Patients with AFMR were older (79.7±6.67 versus 74.6±10.30 years), majority female (75.0% versus 33.3%), and had higher rates of hypertension (98.1% versus 82.3%) and atrial fibrillation (82.7% versus 60.1%) than patients with VFMR (all P<0.05). Patients with VFMR had higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels (3350.0 [1720.0-6564.0] versus 1562.0 [790.0-2286.0]; P<0.001) and more severe mitral regurgitation (≥3+) at baseline (71.9% versus 46.2%; P<0.001). Procedural success was high (AFMR, 96.2%; VFMR, 97.1%; P=0.661), and patients with AFMR had shorter procedure duration (73.5 versus 85.5 minutes; P=0.044). One-year Kaplan-Meier estimate of freedom from all-cause mortality or heart failure hospitalizations was 79.3% in AFMR and 70.9% in VFMR (P=0.267). Both AFMR and VFMR groups demonstrated significant mitral regurgitation reduction (mitral regurgitation ≤1+, 93.1% and 81.3%), low mean transmitral gradients (3.5 and 3.1 mm Hg), significant proportional reductions in left ventricular end-diastolic volume (-12.9% and -16.4%) and left atrial volume (-9.6% and -10.9%), high proportions at New York Heart Association class I/II (76.5% and 64.6%), and significant increases in Kansas City Cardiomyopathy Questionnaire Overall Summary score (+18.0 and +11.6 points), respectively (all P<0.05 from baseline).
CONCLUSIONS
One-year MiCLASP results support the safety of mitral transcatheter edge-to-edge repair with the PASCAL system in both AFMR and VFMR, with comparable echocardiographic, functional, and quality-of-life changes, despite baseline differences in clinical presentation.
A. Mahabadi, T. Rassaf, T. Kister et al.· Circulation. Cardiovascular...· 0 citations
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