Abstract
Objective: We aimed to investigate the demographic, clinical and hemodynamic characteristics of patients who underwent percutaneous mitral valve (MV) repair over the last decade, as well as to determine the potential changes in trends of these parameters among patients with structural and functional MR (SMR and FMR). Methodology: We analyzed all patients who underwent interventional MV repair in our institution between January 2010 and March 2021. Our study included both SMR and FMR patients. All data were obtained from a local registry. Results: Nine hundred and seventeen patients (357 SMR patients and 563 FMR patients) were involved in this study. We did not find significant differences in demographical, clinical and hemodynamic characteristics among SMR and FMR patients. Left ventricular remodeling and systolic dysfunction were more pronounced in FMR patients. Systemic vascular resistance was the only hemodynamic parameter that differed between SMR and FMR patients; it was higher in SMR group. An evaluation of the trend between the first and last five years of our experience revealed that the number of patients treated with this technique is constantly increasing, but that this is more pronounced in SMR patients. It was also found that the operative risk of SMR and FMR patients was significantly higher in the first five years. Additionally, our results showed change in medical therapy in MR patients over the last decade in terms of increased use of angiotensin II receptor blockers and the introduction of angiotensin receptor II blocker-neprilysin inhibitor. Conclusion: SMR and FMR patients who underwent interventional MV repair have similar clinical and hemodynamic characteristics. The percentage of SMR patients increased more significantly than FMR patients over the last five years.
Highlights
Introduction published maps and institutional affilMitral regurgitation (MR) represents the most frequent valvular heart disease; its prevalence is constantly rising [1,2]
Our study revealed several important findings that warrant further discussion: (i) a considerable number of SMR patients is treated mitral valve (MV) to-edge repair (TEER) and their percentage significantly increased over the last 5 years; (ii) there was no significant difference in demographic and clinical characteristics among SMR and functional MR (FMR) patients who were treated over the last decade with this method; (iii) LV remodeling and systolic dysfunction were more pronounced in FMR patients; (iv) systemic vascular resistance was the only invasive hemodynamic parameter that differed between SMR and FMR patients; (v) operative risk of SMR and FMR patients was significantly higher in the first five years; (vi) medical therapy has changed over the last decade in mitral regurgitation (MR) patients in terms of increased use of ARB and introduction of ARNI
The number of patients treated with MV TEER significantly increased over the last few years, but our study showed that in Germany and probably the rest of Europe, the trend is going toward higher increase in the number of patients with SMR than FMR–opposite to what is observed in the US
Summary
Introduction published maps and institutional affilMitral regurgitation (MR) represents the most frequent valvular heart disease; its prevalence is constantly rising [1,2]. Surgical intervention was the only therapeutic option for symptomatic patients with severe MR, mainly SMR, for a long time. Transcatheter edge-to-edge repair (TEER) of the mitral valve (MV) caused a revolution in MR treatment when the MitraClip system (Abbott) was approved in Europe in 2008 for both indications, i.e., SMR and FMR, whereas it was approved in 2013 in the United States and only for SMR [3]. The treatment was primarily intended for FMR patients with very high operative risk, but it was soon adopted as an efficient therapeutic option in SMR patients with unacceptable operative risk [4,5]. More than one decade later, a new system for MV TEER, the PASCAL device (Edwards), was approved in Europe, but still not in the US. The first published data regarding the PASCAL system revealed that MR severity, iations
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