Symptomatic Response to Transcatheter Mitral Valve Repair According to Baseline Left Atrial Pressure

Abstract

ABSTRACT Background: Prior studies have demonstrated that patients with low left atrial pressure (LAP) undergoing transcatheter mitral valve repair (TMVr) have a high incidence of chronic lung disease, and it is unknown whether they symptomatically benefit from repair. The goal of this study was to compare the degree of symptomatic improvement following TMVr in patients according to baseline LAP. Methods: We retrospectively reviewed patients who underwent TMVr with continuous LAP monitoring from May 1, 2014 to January 14, 2020. Patients were grouped according to mean LAP below (group 1) or above (group 2) the median (< or ≥ 18 mmHg, respectively) and symptoms were assessed by New York Heart Association (NYHA) functional class. One-year mortality and symptomatic improvement were compared between groups. Results: In 302 patients, age, sex, left ventricular ejection fraction and mitral regurgitation severity were similar between groups. Patients in group 2 had larger left atrial volume index (73.0 ± 32.2 cc/m2 vs. 67.0 ± 26.0 cc/m2, p = 0.008) and higher baseline mean NYHA class compared to group 1 (3.2 ± 0.5 vs. 3.0 ± 0.6, p = 0.003), but both had significant improvements in NYHA at 1-month (1.9 ± 0.9 vs. 1.8 ± 0.8, both p < 0.0001) and 12-months (1.9 ± 0.8 vs. 2.2 ± 0.9, both p < 0.0001). The predicted one-year survival free of severe class 3 or 4 heart failure symptoms was also similar (58.7% vs. 66.0%, p = 0.33) and there was no difference in estimated one-year survival between groups (77.5% vs. 72.7%, p = 0.89). Conclusion: Patients with severe mitral regurgitation experience a similar symptomatic improvement following TMVr regardless of baseline LAP.