Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: North American Mitraclip for Functional Mitral Regurgitation Registry

Neal M Duggal; Milo Engoren; Scott M Chadderdon; Evelio Rodriguez; M Andrew Morse; Mani A Vannan; Pradeep K Yadav; Michael Morcos; Flora Li; Mark Reisman; Enrique Garcia-Sayan; Deepa Raghunathan; Nishtha Sodhi; Paul Sorajja; Lily Chen; Jason H Rogers; Marcella A Calfon; Christopher P Kovach; Edward A Gill; Firas E Zahr; Stanley J Chetcuti; Yuan Yuan; Graciela B Mentz; D Scott Lim; Gorav Ailawadi

doi:10.1016/j.amjcard.2023.12.020

Mortality Associated With Proportionality of Secondary Mitral Regurgitation After Transcatheter Mitral Valve Repair: North American Mitraclip for Functional Mitral Regurgitation Registry

Am J Cardiol. 2024 Feb 15:213:99-105. doi: 10.1016/j.amjcard.2023.12.020. Epub 2023 Dec 16.

Authors

Neal M Duggal¹, Milo Engoren², Scott M Chadderdon³, Evelio Rodriguez⁴, M Andrew Morse⁵, Mani A Vannan⁶, Pradeep K Yadav⁶, Michael Morcos⁷, Flora Li⁸, Mark Reisman⁹, Enrique Garcia-Sayan¹⁰, Deepa Raghunathan¹⁰, Nishtha Sodhi¹¹, Paul Sorajja¹², Lily Chen¹³, Jason H Rogers¹³, Marcella A Calfon¹⁴, Christopher P Kovach¹⁵, Edward A Gill¹⁵, Firas E Zahr³, Stanley J Chetcuti¹⁶, Yuan Yuan², Graciela B Mentz², D Scott Lim¹¹, Gorav Ailawadi¹⁷

Affiliations

¹ Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan. Electronic address: [email protected].
² Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
³ Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon.
⁴ Department of Cardiothoracic Surgery, Ascension Saint Thomas Heart, Nashville, Tennessee.
⁵ Division of Cardiology, Ascension Saint Thomas Heart, Nashville, Tennessee.
⁶ Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
⁷ Division of Cardiology, University of Washington, Seattle, Washington.
⁸ Department of Anesthesiology, University of Washington, Seattle, Washington.
⁹ Division of Cardiology, Weill Cornell Medical Center, New York, New York.
¹⁰ Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas.
¹¹ Division of Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
¹² Valve Science Center, Minneapolis Heart Institute, Abbott Northwestern Medical Center, Minneapolis, Minnesota.
¹³ Division of Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, California.
¹⁴ Division of Cardiology, University of California Los Angeles, Los Angeles, California.
¹⁵ Division of Cardiology, University of Colorado, Aurora, Colorado.
¹⁶ Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
¹⁷ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.

PMID: 38110022
DOI: 10.1016/j.amjcard.2023.12.020

Abstract

The association, if any, between the effective regurgitant orifice area (EROA) to left ventricular end-diastolic volume (LVEDV) ratio and 1-year mortality is controversial in patients who undergo mitral transcatheter edge-to-edge repair (m-TEER) with the MitraClip system (Abbott Vascular, Santa Clara, CA). This study's objective was to determine the association between EROA/LVEDV and 1-year mortality in patients who undergo m-TEER with MitraClip. In patients with severe secondary (functional) mitral regurgitation (MR), we analyzed registry data from 11 centers using generalized linear models with the generalized estimating equations approach. We studied 525 patients with secondary MR who underwent m-TEER. Most patients were male (63%) and were New York Heart Association class III (61%) or IV (21%). Mitral regurgitation was caused by ischemic cardiomyopathy in 51% of patients. EROA/LVEDV values varied widely, with median = 0.19 mm²/ml, interquartile range [0.12,0.28] mm²/ml, and 187 patients (36%) had values <0.15 mm²/ml. Postprocedural mitral regurgitation severity was substantially alleviated, being 1+ or less in 74%, 2+ in 20%, 3+ in 4%, and 4+ in 2%; 1-year mortality was 22%. After adjustment for confounders, the logarithmic transformation (Ln) of EROA/LVEDV was associated with 1-year mortality (odds ratio 0.600, 95% confidence interval 0.386 to 0.933, p = 0.023). A higher Society of Thoracic Surgeons risk score was also associated with increased mortality. In conclusion, lower values of Ln(EROA/LVEDV) were associated with increased 1-year mortality in this multicenter registry. The slope of the association is steep at low values but gradually flattens as Ln(EROA/LVEDV) increases.

Keywords: functional mitral regurgitation; mitral transcatheter edge-to-edge repair; proportionality; regurgitant orifice.

Publication types

Multicenter Study

MeSH terms

Female
Heart Valve Prosthesis Implantation*
Humans
Male
Mitral Valve / surgery
Mitral Valve Insufficiency* / epidemiology
Mitral Valve Insufficiency* / surgery
North America
Registries
Treatment Outcome