Predictors of heart failure rehospitalization in mitral transcatheter edge-to-edge repair (M-TEER) based on residual mitral regurgitation: a single center study
M Biswas, M Sharpe, L E Sade, J Fowler, A J Smith, W Katz, M SuffolettoAbstract
Background
M-TEER is a minimally invasive management strategy for patients with symptomatic and severe mitral regurgitation (MR). M-TEER can decrease mortality for patients with no surgical options. We assessed the effect of residual MR after M-TEER on quality of life and predictors of heart failure (HF) rehospitalization.
Methods
From 7/2014 through 1/2024, patients with severe MR underwent M-TEER with the Pascal or Mitraclip system. Data was collected from the TVT Registry. Post-TEER MR severity was categorized as none-to-mild vs moderate-or-greater, and the groups were compared based on quality-of-life metrics, tricuspid regurgitation (TR) severity, and HF rehospitalizations.
Results
430 patients underwent M-TEER over the 10-year period. 45% were females. The average LVEF remained relatively unchanged from pre-TEER (51%) to post-TEER (50%). Post-TEER residual MR was associated with greater 1-year HF rehospitalization, independent of MR type (functional vs. degenerative). Higher pre- and post-op NYHA class was significantly associated with post-TEER residual MR. Residual MR was associated with lower KCCQ-12 scores at 1-month post-op. Higher post-TEER TR severity was associated with increased 1-year HF rehospitalization rate.
Conclusion
Reduction in MR after M-TEER led to significant quality of life improvement as seen by improved NYHA class, KCCQ-12 scores, and reduced HF rehospitalizations. Residual MR after M-TEER and worse right-sided function assessed by TR severity were associated with increased HF admissions. Although the benefit to M-TEER has been seen, differentiating patients pre-disposed to group 2 PH may be helpful for prognostication and to target additional medical management to prevent HF hospitalizations.Figure 1For image description, please refer to the figure legend and surrounding text.