Prognostic Value of Prolapse Width for Mid‐Term Degenerative Mitral Regurgitation Stability After Transcatheter Edge‐to‐Edge Repair
Xinping Lin, Boren Tan, Cheng Li, Jie Liang, Huixiang Yan, Qifeng Zhu, Xianbao LiuABSTRACT
Background
Long‐term durability of degenerative mitral regurgitation (DMR) reduction after transcatheter edge‐to‐edge repair (TEER) remains limited, and reliable anatomical predictors are still lacking.
Methods
This study prospectively enrolled patients with symptomatic DMR undergoing TEER across 27 centers in China. All pre‐procedural clinical and echocardiographic parameters were collected and analyzed. The primary outcome was MR ≤ 1+ at 3‐year follow‐up. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify predictors and optimal cutoff values.
Results
A total of 78 patients with available 3‐year echocardiographic assessments were included in the imaging‐based analysis (mean age, 74.4 ± 5.1 years; 67.9% with NYHA class III/IV symptoms; mean STS score for mitral valve replacement, 6.8 ± 2.7%). At 3‐year follow‐up, 49 patients (62.8%) maintained MR ≤1+. TEER was associated with significant reverse cardiac remodeling, including reductions in left ventricular end‐diastolic volume (125.4 ± 40.6 to 99.8 ± 19.7 mL) and pulmonary artery systolic pressure (43.0 ± 11.6 to 34.3 ± 11.4 mmHg) (both p < 0.001), while LVEF remained stable. Mitral valve (MV) prolapse/flail width independently predicted MR durability (OR: 0.789; 95% CI: 0.655–0.951; p = 0.013). ROC analysis identified a cutoff value of 16 mm (AUC: 0.714; p = 0.002), with patients having prolapse/flail width ≥16 mm demonstrating lower rates of MR ≤1+ at 3 years.
Conclusions
Pre‐procedural prolapse/flail width is an independent predictor of 3‐year MR durability after TEER in patients with DMR. Larger prolapse/flail width is associated with reduced mid‐term MR stability, suggesting its potential value for risk stratification and procedural planning.
Trial Registration
This study has been registered at ClinicalTrials.gov with a number of NCT04734756.