Transcatheter Edge-to-Edge Repair for Treatment of Atrial Secondary Mitral Regurgitation

Transcatheter edge-to-edge repair (TEER) is safe and feasible among patients with atrial secondary mitral regurgitation, according to results of a study published in JACC: Cardiovascular Interventions.

Data were sourced from the University Hospital Bonn in Germany. Patients (N=415) with symptomatic mitral regurgitation that received TEER with MitraClip between 2010 and 2021 were evaluated for safety and feasibility. Efficacy of TEER was defined as a regurgitation reduction of 1+ or less.

Patients had either ventricular secondary mitral regurgitation (n=297) or atrial secondary mitral regurgitation (n=118). The patient cohorts comprised 65.0% and 39.8% men (P <.001); were aged mean 76±8 and 80±8 years (P <.001); BMI was 26.3±5.0 and 26.5±5.1; 75.1% and 75.4% had hypertension; 73.1% and 90.7% had atrial fibrillation (P <.001); and 33.0% and 23.7% had received a prior cardiac procedure, respectively.

During TEER, 51.7% of the atrial secondary mitral regurgitation cohort received 1 clip. Technical success was achieved among 94.1% of patients and TEER was effective among 79.7%. The efficacy rate was similar between the atrial secondary mitral regurgitation cohort and the ventricular secondary mitral regurgitation cohort (71.4%). The in-hospital mortality rate was 2.5%.

At the 3-month and 1-year follow-ups, no patients in the atrial secondary mitral regurgitation cohort had severe regurgitation compared with 1.9% and 3.3% among the ventricular secondary mitral regurgitation cohort, respectively.

Achievement of a regurgitation reduction of 1+ or less among the atrial secondary mitral regurgitation cohort was associated with leaflet-to-annulus index (LAI) per 0.1 increase (odds ratio [OR], 1.98; 95% CI, 1.13-3.45; P =.017) and left atrial (LA) volume index per mL/m² increase (OR, 0.98; 95% CI, 0.97-0.99; P =.015).

Stratified by LA dilation, defined as 85 mL/m², and high LAI, defined as 1.10, better regurgitation reductions were achieved by patients without severe LA dilation and high LAI (90.7%), followed by severe LA dilation or low LAI (76.0%), and severe LA dilation and low LAI (41.7%).

Stratified by MitraClip systems, a reduction of regurgitation of 1+ or less rates were highest for MitraClipG4 (94.7%) and MitraClip NTR/XTR (85.7%) compared with MitraClip NT (68.4%; all P £.038).

This study is limited by its single center retrospective design.

“TEER with the MitraClip system achieved a high rate of MR reduction to £1+ in patients with ASMR [atrial secondary mitral regurgitation], which was comparable to VSMR [ventricular secondary mitral regurgitation] patients,” the study authors wrote. “Among the echocardiographic parameters, a large LA volume index and a low LAI were associated with insufficient MR reduction by TEER.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Tanaka T, Sugiura A, Öztürk C, et al. Transcatheter edge-to-edge repair for atrial secondary mitral regurgitation. JACC Cardiovasc Interv. Published online August 22, 2022. doi:10.1016/j.jcin.2022.06.005