Abstract 13106: Two-Year Clinical Outcomes of Staged Transcatheter Mitral Edge-to-Edge Repair After Transcatheter Aortic Valve Replacement

Abstract

Introduction: Residual significant MR has been linked to an increased risk of adverse clinical events in patients undergoing TAVR. However, the effectiveness of staged TEER after TAVR has been poorly assessed. Hypothesis: To investigate clinical outcomes of staged transcatheter edge-to-edge repair (TEER) for residual significant mitral regurgitation (MR) after transcatheter aortic valve replacement (TAVR). Methods: This observational study included consecutive patients with residual grade 3+ or 4+ MR after TAVR performed at our institution between April 2016 and November 2020. The primary composite outcomes were all-cause mortality and heart failure (HF) hospitalization at 2 years, with HF hospitalization assessed as a secondary outcome for all-cause mortality. Additional analyses, including changes in MR grade and New York Heart Association (NYHA) functional classification, were performed. Results: Among 314 patients, 104 (33.1%) treated with staged TEER and 210 (66.9%) treated with medical therapy alone were enrolled. Patients who underwent staged TEER had a lower rate of primary composite outcomes than those who received medical therapy alone (33.7% vs. 48.1%, p=0.027) (Figure1). However, there was no significant difference in all-cause mortality (11.5% vs. 13.8%, p=0.46) or HF hospitalization (31.7% vs. 42.9%, p=0.061). Staged TEER was associated with a marked improvement in the MR grade and NYHA class from baseline to 2 years. Conclusions: Staged TEER following TAVR was associated with improved clinical outcomes and a reduced MR grade. The findings suggest that TEER should be considered a potential treatment option for significant residual MR in patients who have previously undergone TAVR.