High procedural success despite limited prognostic value of acute haemodynamics after TEER

Background

Transcatheter edge-to-edge repair (TEER) produces immediate haemodynamic improvement, commonly assessed by reductions in left atrial (LA) pressure and V-wave amplitude. These acute haemodynamic changes are frequently interpreted as markers of procedural success; however, their relationship with technical success and longer-term clinical outcomes remains uncertain. We aimed to evaluate whether acute haemodynamic response to TEER predicts procedural success or subsequent clinical outcomes.

Methods

We retrospectively analysed consecutive patients undergoing TEER at a tertiary referral centre. Invasive haemodynamic parameters, including mean LA pressure and LA V-wave amplitude, were recorded before and after clip implantation. Procedural success was defined as residual mitral regurgitation (MR) ≤2 and mean mitral valve gradient <5 mmHg. Clinical outcomes included all-cause mortality and heart failure (HF) hospitalisation at 30 days and 1 year, as well as a composite endpoint of death or HF hospitalisation. Associations between haemodynamic changes, procedural success, and clinical outcomes were assessed using non-parametric statistical methods.

Results

A total of 77 patients underwent TEER, with significant acute haemodynamic improvement observed following the procedure. Mean LA pressure decreased by 12.1 ± 8.0 mmHg, and LA V-wave amplitude was substantially reduced. Procedural success was achieved in 46 patients (59.7%). However, the magnitude of LA pressure reduction did not differ between patients with and without procedural success (12.3 ± 8.1 vs 11.7 ± 7.9 mmHg; p=0.72). Similarly, changes in LA pressure and V-wave amplitude were not associated with post-procedural MR grade.

At 1 year, all-cause mortality occurred in 13.8% of patients and HF hospitalisation in 18.5%, with a composite endpoint rate of 9.1%. Neither the absolute nor relative reduction in LA pressure or V-wave amplitude was associated with mortality, HF hospitalisation, or the composite endpoint at follow-up (all p>0.05).

Conclusions

TEER results in marked acute haemodynamic improvement; however, the magnitude of LA pressure and V-wave reduction does not predict procedural success or subsequent clinical outcomes. These findings suggest that acute haemodynamic response reflects immediate physiological unloading rather than durable technical or prognostic success, underscoring the need for caution when using intraprocedural haemodynamics as surrogate endpoints following TEER.graph abstract