Endoscopic repair of atrial functional mitral regurgitation in heart failure: long-term effects

Abstract

Abstract Introduction In patients with heart failure and preserved ejection fraction (HFpEF), even mild atrial functional mitral regurgitation (AFMR) has been associated with poor outcome. Objective To describe long-term effects of endoscopic mitral valve (MV) repair on outcome in patients with HFpEF and AFMR. Methods The study population consisted of consecutive patients with HFpEF (LVEF ≥50%, H2FPEF score ≥5) and AFMR, who underwent isolated, minimally invasive (endoscopic), MV repair (MVRepair group) (n=131) or remained on standard of care (StanCare group) (n=139). Patients with coronary artery disease or organic MR were excluded. Patients were matched using inverse probability of treatment weighting. Primary objective was all-cause mortality or HFpEF readmissions. Results The median follow up was 5.03 years (IQR 2.6–7.9 years). In the MVRepair group, the perioperative, 30-day, 1- and 5-year mortality was 0, 1% and 12%, respectively. Additional 13 (10%) patients were readmitted for worsening HFpEF, while 2 (1%) individuals underwent redo MV surgery for recurrent MR. MVRepair compared with StanCare showed 21–29% (SE 6–8%) and 19–26% (SE 6–8%) absolute risk reduction of all-cause mortality and HFpEF readmissions, respectively (all p<0.05). MVRepair emerged as the strongest independent predictor of all-cause mortality (HR 0.16, 95% CI 0.07–0.34, p<0.001) and HFpEF readmissions (HR 0.21, 95% CI 0.09–0.51, p<0.001). At 5-year follow-up, in the MVRepair group, a total of 88% were alive and 80% were alive without readmission for HFpEF. Conclusions Endoscopic MV repair is associated with low perioperative mortality, high long-term efficacy and appears to improve clinical outcome in patients with AFMR and HFpEF. Mortality and readmission for HF Funding Acknowledgement Type of funding source: None