Impact of pulmonary hypertension on short and long-term outcome after mitral transcatheter edge-to-edge repair: A meta-analysis

Background: Pulmonary hypertension (pHTN) has been associated with increased morbidity and mortality after mitral Transcatheter Edge-to-Edge Repair (TEER), but the association remains uncertain. This study aims to evaluate the impact of pHTN on cardiovascular outcomes following TEER.

Methods: We searched PubMed, Scopus, and Medline to identify studies reporting outcomes after TEER in individuals with pHTN. Utilizing a random-effects model, we ascertained a pooled odds ratio (OR) of clinical outcomes in patients with pulmonary artery systolic pressure (PASP >50 mmHg) vs. without (PASP <50 mmHg) severe pHTN.

Results: We included seven studies with 27,965 patients. The mean age was 79.9 (±5.2) years; 53 % were male, and 75 % were New York Heart Association (NYHA) class-III/IV with a median follow-up of 360 days. Patients with severe pHTN had higher odds of in-hospital all-cause mortality (OR: 1.99, 95 % CI: 1.69-2.34, p < 0.00001) and Major adverse cardiovascular events (MACE) (OR: 1.38, 95 % CI: 1.22-1.56, p < 0.00001) compared to patients without severe pHTN.

Conclusions: Severe pHTN is associated with increased risks of all-cause mortality, MACE, and higher heart failure rehospitalizations in patients undergoing mitral TEER. Prospective trials are necessary to validate the findings and determine if early intervention improves clinical outcomes.