Transcatheter Mitral Valve Repair for Multiple Valvular Heart Disease: Outcomes and Insights on Combined Aortic Insufficiency and Mitral Regurgitation

Craig Basman; Ahmad Mustafa; Arber Kodra; Denny Wang; Priyanka Singh; Ethan Paliwoda; Christopher Gasparis; Ythan Goldberg; Shangyi Liu; Chapman Wei; Michael Cinelli; Efstathia Mihelis; Caroline Ong; Biana Trost; Bruce Rutkin; Elana Koss; Gregory Maniatis; Sean Wilson; Jacob Scheinerman; Chad Kliger

doi:10.1016/j.amjcard.2024.09.032

Transcatheter Mitral Valve Repair for Multiple Valvular Heart Disease: Outcomes and Insights on Combined Aortic Insufficiency and Mitral Regurgitation

Am J Cardiol. 2024 Dec 15:233:45-50. doi: 10.1016/j.amjcard.2024.09.032. Epub 2024 Oct 9.

Authors

Craig Basman¹, Ahmad Mustafa¹, Arber Kodra¹, Denny Wang¹, Priyanka Singh¹, Ethan Paliwoda¹, Christopher Gasparis¹, Ythan Goldberg¹, Shangyi Liu¹, Chapman Wei¹, Michael Cinelli¹, Efstathia Mihelis¹, Caroline Ong¹, Biana Trost¹, Bruce Rutkin¹, Elana Koss¹, Gregory Maniatis¹, Sean Wilson¹, Jacob Scheinerman¹, Chad Kliger²

Affiliations

¹ Northwell Health, New Hyde Park, New York.
² Northwell Health, New Hyde Park, New York. Electronic address: [email protected].

PMID: 39389282
DOI: 10.1016/j.amjcard.2024.09.032

Abstract

The presence of concomitant aortic insufficiency (AI) and mitral regurgitation (MR) is common and may further accelerate cardiac dysfunction. However, there exists no US regulatory-approved transcatheter device for the treatment of AI. The effectiveness of isolated transcatheter mitral therapy in this population is not well-understood; thus, we aimed to evaluate outcomes for patients with combined AI and MR compared with isolated MR who underwent mitral transcatheter edge-to-edge repair (m-TEER). Retrospective data were obtained from the Northwell m-TEER registry. A total of 587 patients who underwent m-TEER at 4 high-volume transcatheter aortic valve replacement/transcatheter edge-to-edge repair centers within the Northwell Health system were included. All patients had severe MR and were divided into 2 groups: group 1 with ≥3+ AI (AI+) and the group 2 with <3+ AI (AI-). Echocardiographic outcomes were evaluated at 1 month. Clinical outcomes were evaluated at 1 month and 1 year. The primary end point was death or rehospitalization at 1 year. A total of 587 patients were included in the study, with 92 in the AI+ group. Baseline characteristics were similar in both groups. Approximately 2/3 of patients in the AI+ group demonstrated an improvement in AI severity after isolated mitral therapy. There was no difference in the primary outcome at 1 month or 1 year. There was also no significant difference in New York Heart Association functional class at 1 month between the groups. In conclusion, patients who underwent m-TEER with combined MR and AI (AI+ group) fared well compared with those with isolated mitral valve dysfunction (AI- group), with no discernible differences in survival, New York Heart Association class, or rehospitalization rates at 1 month or 1 year. Hence, isolated m-TEER is a reasonable treatment approach in patients with a high surgical risk with combined AI and MR.

Keywords: aortic insufficiency; mitral regurgitation; mitral transcatheter edge-to-edge repair.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Aortic Valve Insufficiency* / complications
Aortic Valve Insufficiency* / surgery
Cardiac Catheterization* / methods
Echocardiography
Female
Follow-Up Studies
Heart Valve Prosthesis Implantation / methods
Humans
Male
Mitral Valve / diagnostic imaging
Mitral Valve / surgery
Mitral Valve Insufficiency* / complications
Mitral Valve Insufficiency* / physiopathology
Mitral Valve Insufficiency* / surgery
Patient Readmission / statistics & numerical data
Registries
Retrospective Studies
Transcatheter Aortic Valve Replacement / methods
Treatment Outcome