Identifying Patients With Secondary Mitral Regurgitation and Heart Failure who may Benefit From Transcatheter Edge-to-Edge Repair in the Wellington Region

Abstract

As the New Zealand population ages, the incidence of heart failure and valvular disease increases. The Cardiovascular Outcomes Assessment of MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial showed decreased rates of hospitalisation for heart failure and all-cause mortality with transcatheter edge-to-edge repair (TEER) for clinically significant secondary mitral regurgitation (MR) within 24 months of follow-up compared with medical therapy. This retrospective observational study aimed to identify patients who may benefit from TEER in Wellington. This study retrospectively reviewed the electronic records of 337 consecutive patients aged ≥18 years who presented to Wellington Hospital from April to September 2022 with heart failure and identified those who met modified COAPT criteria: at least moderate secondary mitral regurgitation, left ventricular ejection fraction (LVEF) 20%–50% on echocardiography, and who did not meet criteria for cardiac surgery or other valve intervention. Forty patients met the modified COAPT criteria: 27 (68%) were male and 13 (33%) were female. The mean age was 71.7 years. Of them, 55% were New Zealand European, 23% were Pasifika, and 13% were New Zealand Māori. A total of 58% had moderate MR, 33% had moderate–severe MR, and 10% had severe MR; the median LVEF was 30%. The median survival was 309 days in those who met the modified COAPT criteria compared with 365 days in those who did not (non-statistically significant). Among patients who presented to Wellington Hospital with heart failure, a significant proportion (11.9%) had clinically significant secondary MR, who trend towards shorter survival times compared with those who present with heart failure in general. According to international guidelines and trial data such as COAPT, these patients would have potentially benefitted from TEER.