E-44 | Integration of Residual Mitral Regurgitation and Left Atrial Pressure For Outcome Prediction with Mitral Transcatheter Edge-to-edge Repair

Abstract

BackgroundWhile left atrial pressure (LAP) reflects hemodynamic load in patients with mitral regurgitation, there is uncertainty regarding the incremental utility of its measurement in patients undergoing mitral transcatheter edge-to-edge repair (TEER).MethodsWe examined outcomes of mitral TEER with MitraClip according to an integrated approach entailing LAP and MR assessment in 379 consecutive patients. Patients were categorized into 3 groups according post-procedural residual MR and mean LAP (mLAP): Group 1, grade ≤1 MR and mLAP ≤15 mmHg; Group 2, MR grade >1 or mLAP >15 mmHg; and Group 3, MR grade >1 and mLAP >15 mmHg. Primary endpoints for the study were all-cause mortality, and the combination of death and re-hospitalization for heart failure at 1-year follow-up after TEER.ResultsOverall, the patient population (median age, 82 years; 43.8% women) consisted mainly of patients with primary MR (83.1%) and severe symptoms (92.3%). For the endpoint of all-cause mortality, event-free survival at 1-year was 91.6%, 82.6%, and 67.9% for Groups 1, 2, and 3, respectively (HR 2.13, 95% CI, 1.44 to 3.15) (p<0.001). For the combined endpoint of all-cause mortality and re-hospitalization for heart failure, event-free survival at 1-year was 84.1%, 70.7% , and 53.2% for Groups 1, 2, and 3, respectively (HR 1.93, 95% CI, 1.41 to 2.65) (p<0.001) (Figure).ConclusionsDisclosuresS. Garcia: Edwards Lifesciences: Consulting and Principal Investigator for a Research Study; Medtronic: Consulting; M. Goessl: speaker's bureau for Abbott Vascular; consulting for LivaNova; research support from Edwards Lifesciences: Consulting; P. Sorajja: Abbott: Advisory Board/Board Member and Consulting; H. Sato Nothing to disclose. BackgroundWhile left atrial pressure (LAP) reflects hemodynamic load in patients with mitral regurgitation, there is uncertainty regarding the incremental utility of its measurement in patients undergoing mitral transcatheter edge-to-edge repair (TEER). While left atrial pressure (LAP) reflects hemodynamic load in patients with mitral regurgitation, there is uncertainty regarding the incremental utility of its measurement in patients undergoing mitral transcatheter edge-to-edge repair (TEER). MethodsWe examined outcomes of mitral TEER with MitraClip according to an integrated approach entailing LAP and MR assessment in 379 consecutive patients. Patients were categorized into 3 groups according post-procedural residual MR and mean LAP (mLAP): Group 1, grade ≤1 MR and mLAP ≤15 mmHg; Group 2, MR grade >1 or mLAP >15 mmHg; and Group 3, MR grade >1 and mLAP >15 mmHg. Primary endpoints for the study were all-cause mortality, and the combination of death and re-hospitalization for heart failure at 1-year follow-up after TEER. We examined outcomes of mitral TEER with MitraClip according to an integrated approach entailing LAP and MR assessment in 379 consecutive patients. Patients were categorized into 3 groups according post-procedural residual MR and mean LAP (mLAP): Group 1, grade ≤1 MR and mLAP ≤15 mmHg; Group 2, MR grade >1 or mLAP >15 mmHg; and Group 3, MR grade >1 and mLAP >15 mmHg. Primary endpoints for the study were all-cause mortality, and the combination of death and re-hospitalization for heart failure at 1-year follow-up after TEER. ResultsOverall, the patient population (median age, 82 years; 43.8% women) consisted mainly of patients with primary MR (83.1%) and severe symptoms (92.3%). For the endpoint of all-cause mortality, event-free survival at 1-year was 91.6%, 82.6%, and 67.9% for Groups 1, 2, and 3, respectively (HR 2.13, 95% CI, 1.44 to 3.15) (p<0.001). For the combined endpoint of all-cause mortality and re-hospitalization for heart failure, event-free survival at 1-year was 84.1%, 70.7% , and 53.2% for Groups 1, 2, and 3, respectively (HR 1.93, 95% CI, 1.41 to 2.65) (p<0.001) (Figure). Overall, the patient population (median age, 82 years; 43.8% women) consisted mainly of patients with primary MR (83.1%) and severe symptoms (92.3%). For the endpoint of all-cause mortality, event-free survival at 1-year was 91.6%, 82.6%, and 67.9% for Groups 1, 2, and 3, respectively (HR 2.13, 95% CI, 1.44 to 3.15) (p<0.001). For the combined endpoint of all-cause mortality and re-hospitalization for heart failure, event-free survival at 1-year was 84.1%, 70.7% , and 53.2% for Groups 1, 2, and 3, respectively (HR 1.93, 95% CI, 1.41 to 2.65) (p<0.001) (Figure). Conclusions DisclosuresS. Garcia: Edwards Lifesciences: Consulting and Principal Investigator for a Research Study; Medtronic: Consulting; M. Goessl: speaker's bureau for Abbott Vascular; consulting for LivaNova; research support from Edwards Lifesciences: Consulting; P. Sorajja: Abbott: Advisory Board/Board Member and Consulting; H. Sato Nothing to disclose. S. Garcia: Edwards Lifesciences: Consulting and Principal Investigator for a Research Study; Medtronic: Consulting; M. Goessl: speaker's bureau for Abbott Vascular; consulting for LivaNova; research support from Edwards Lifesciences: Consulting; P. Sorajja: Abbott: Advisory Board/Board Member and Consulting; H. Sato Nothing to disclose.