Impact of Right Ventricular Dysfunction on Outcomes After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation

JACC-CARDIOVASCULAR IMAGING

卷:14

Article

Karam, Nicole^1,2  Stolz, Lukas³  Orban, Mathias^3,4  Deseive, Simon³  Praz, Fabien⁵  Kalbacher, Daniel⁶  Westermann, Dirk⁶  Braun, Daniel³  Nabauer, Michael³  Neuss, Michael⁷  Butter, Christian⁷  Kassar, Mohammad⁵  Petrescu, Aniela⁸  Pfister, Roman⁹  Iliadis, Christos⁹  Unterhuber, Matthias¹⁰  Park, Sang-Don³  Thiele, Holger¹⁰  Baldus, Stephan⁹  von Bardeleben, Ralph Stephan⁸  Blankenberg, Stefan⁶  Massberg, Steffen^3,4  Windecker, Stephan⁵  Lurz, Philipp¹⁰  Hausleiter, Joerg^3,4 

[1] Hop Europeen Georges Pompidou, Dept Cardiol, Paris, France

[2] Paris Cardiovasc Res Ctr, INSERM U970, Paris, France

[3] Klinikum Univ Munchen, Med Klin & Poliklin 1, Dept Cardiol, Munich, Germany

[4] German Ctr Cardiovasc Dis, Munich Heart Alliance, Partner Site, Munich, Germany

[5] Inselspital Bern, Univ Klin Kardiol, Bern, Switzerland

[6] Univ Herz & Gefasszentrum Hamburg, Kardiol Klin, Hamburg, Germany

[7] Med Hsch Brandenburg Theodor Fontane, Herzzentrum Brandenburg, Bernau, Germany

[8] Johannes Gutenberg Univ Mainz, Zentrum Kardiol, Mainz, Germany

[9] Univ Cologne, Ctr Heart, Dept Internal Med 3, Cologne, Germany

[10] Univ Leipzig, Heart Ctr Leipzig, Dept Cardiol, Leipzig, Germany

关键词: edge-to-edge repair;    outcome;    right ventricular function;    right ventricular-to-pulmonary artery coupling;    secondary mitral regurgitation;    tricuspid regurgitation;   

DOI  :  10.1016/j.jcmg.2020.12.015

来源: Elsevier

【 摘 要 】

OBJECTIVES This study sought to assess the impact of right ventricular dysfunction (RVD) as defined by impaired right ventricular-to-pulmonary artery (RV-PA) coupling, on survival after edge-to-edge transcatheter mitral valve repair (TMVR) for severe secondary mitral regurgitation (SMR). BACKGROUND Conflicting data exist regarding the benefit of TMVR in severe SMR. A possible explanation could be differences in RVD. METHODS Using data from the EuroSMR (European Registry on Outcomes in Secondary Mitral Regurgitation) registry, this study compared the characteristics and outcomes of SMR patients undergoing TMVR, according to their RV-PA coupling, assessed by tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure (TAPSE/sPAP) ratio. RESULTS Overall, 817 patients with severe SMR and available RV-PA coupling assessment underwent TMVR in the participating centers. RVD was present in 211 patients (25.8% with a TAPSE/sPAP ratio <0.274 mm/mm Hg). Although all patients demonstrated significant improvement in their New York Heart Association (NYHA) functional class, there was a trend toward a lower rate of NYHA functional class I or II among patients with RVD (56.5% vs. 65.5%, respectively; p = 0.086) after TMVR. Survival rates at 1 and 2 years were lower among patients with RVD (70.2% vs. 84.0%, respectively; p < 0.001; and 53.4% vs. 73.1%, respectively; p < 0.001). On multivariate analysis, a reduced TAPSE/sPAP ratio was a strong predictor of mortality (odds ratio: 1.62; 95% confidence interval: 1.14 to 2.31; p = 0.007). CONCLUSIONS RVD, as shown by impairment of RV-PA coupling, is a major predictor of adverse outcome in patients undergoing TMVR for severe SMR. The often neglected functional and anatomic RV parameters should be systematically assessed when planning TMVR procedures for patients with severe SMR. (C) 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

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