Early symptomatic benefit indicates long-term prognosis after transcatheter mitral valve edge-to-edge repair in functional and degenerative etiology.

Abstract

BACKGROUND\nMitral regurgitation (MR) is common in patients with heart failure and constitutes an independent risk factor for adverse prognosis besides NYHA-class. The predictive value of dyspnea reduction after transcatheter mitral valve repair (TMVr) on outcome has not been investigated up to now.\n\n\nMETHODS AND RESULTS\nWe enrolled 627 consecutive patients (47.0% female, 57.4% functional MR; median follow-up 486\u202fdays[IQR 157/961]; survival status available in 96.8%; symptoms assessed in n\u202f=\u202f556 at baseline / n\u202f=\u202f406 at 1\u202fmonth) treated with isolated percutaneous mitral valve edge-to-edge repair in our center from 06/2010-03/2018 (exclusion of combined forms of TMVr) in a monocentric retrospective analysis. Survival was 97.6% at discharge, 73.9% after 1, 54.5% after 3, 37.6% after 5 and 21.7% after 7-years. Before TMVr, NYHA-classes III/IV were found in 89.0%. Of these, 74.7% reported symptomatic relief (reduction in NYHA-class) one month after procedure (NYHA class recorded in 406 patients at 30\u202fdays). NYHA-classes III/IV were documented in 37.2% (p\u202f<\u202f0.001) at 30\u202fdays and in 36.6% (p\u202f<\u202f0.001) at 1\u202fyear without significant changes between the follow-ups. Dyspnea reduction was accompanied by significantly improved long-term survival (1\u202fyear, 89.1 vs 71.2%, p\u202f=\u202f0.001, 2\u202fyears: 75.5 vs 58.7%, p\u202f=\u202f0.039) and was identified as an independent predictor for lower mortality (1-year HR for increased mortality by missing symptomatic improvement 2.94 [95%CI 1.53-5.65], p\u202f=\u202f0.001; long-term HR 1.95 [95%CI 1.29-2.94], p\u202f=\u202f0.001) independently in both etiologies of MR.\n\n\nCONCLUSION\nTMVr by edge-to-edge therapy enables early and sustainable symptomatic improvement in nearly 75% of the symptomatic patients. The simple assessment of postinterventional changes in NYHA-class might serve as an independent predictor for mid- and long-term prognosis in both FMR and DMR.