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Relation of residual mitral regurgitation and gradient following mitral valve transcatheter edge-to-edge repair

BACKGROUND: - Residual mitral regurgitation (rMR) ≤1+ has been associated with improved 1-year outcomes after mitral valve transcatheter edge-to-edge repair, regardless of the mean mitral pressure gradient (MPG). Prior evidence is limited to 30-day echocardiographic follow-up and patients treated wi...

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Hauptverfasser: Mustafa, Donika (VerfasserIn) , von Stein, Jennifer (VerfasserIn) , Stolz, Lukas (VerfasserIn) , Haurand, Jean Marc (VerfasserIn) , Gröger, Matthias (VerfasserIn) , Rudolph, Felix (VerfasserIn) , Jobst, Jannik (VerfasserIn) , Mues, Christoph Alexander (VerfasserIn) , Mahabadi, Amir Abbas (VerfasserIn) , Hörbrand, Isabel (VerfasserIn) , Schulz, Carl (VerfasserIn) , Sugiura, Atsushi (VerfasserIn) , Lurz, Philipp (VerfasserIn) , Kister, Tobias (VerfasserIn) , Sagmeister, Paula (VerfasserIn) , Wolff, Charlotte (VerfasserIn) , Gerçek, Muhammed (VerfasserIn) , Horn, Patrick (VerfasserIn) , Kessler, Mirjam (VerfasserIn) , Ascione, Guido (VerfasserIn) , Rassaf, Tienush (VerfasserIn) , Weber, Marcel (VerfasserIn) , Schofer, Niklas (VerfasserIn) , Konstandin, Mathias (VerfasserIn) , Schindhelm, Florian (VerfasserIn) , Möllmann, Helge (VerfasserIn) , Unsöld, Bernhard (VerfasserIn) , Guthoff, Henning (VerfasserIn) , Baldus, Stephan (VerfasserIn) , Rottbauer, Wolfgang (VerfasserIn) , Rudolph, Volker (VerfasserIn) , Granada, Juan F. (VerfasserIn) , Hausleiter, Jörg (VerfasserIn) , Pfister, Roman (VerfasserIn) , Mauri, Victor (VerfasserIn) , von Stein, Philipp (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: 28 October 2025
In: Circulation. Cardiovascular interventions
Year: 2025, Jahrgang: 18, Heft: 11, Pages: ?
ISSN:1941-7632
DOI:10.1161/CIRCINTERVENTIONS.125.015845
Online-Zugang:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1161/CIRCINTERVENTIONS.125.015845
Verlag, lizenzpflichtig, Volltext: https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.125.015845
Volltext
Verfasserangaben:Donika Mustafa, Cand. Med., Jennifer von Stein, MD, Lukas Stolz, MD, Jean Marc Haurand, MD, Matthias Gröger, MD, Felix Rudolph, MD, Jannik Jobst, MD, Christoph Alexander Mues, MD, Amir Abbas Mahabadi, MD, Isabel A. Hoerbrand, MD, Carl Schulz, MD, Atsushi Sugiura, MD, Philipp Lurz, MD, Tobias Kister, MD, Paula Sagmeister, MD, Charlotte Wolff, MD, Muhammed Gerçek, MD, Patrick Horn, MD, Mirjam Kessler, MD, Guido Ascione, MD, Tienush Rassaf, MD, Marcel Weber, MD, Niklas Schofer, MD, Mathias H. Konstandin, MD, Florian Schindhelm, MD, Helge Möllmann, MD, Bernhard Unsöld, MD, Henning Guthoff, MD, Stephan Baldus, MD, Wolfgang Rottbauer, MD, Volker Rudolph, MD, Juan F. Granada, MD, Jörg Hausleiter, MD, Roman Pfister, MD, Victor Mauri, MD, and Philipp von Stein, MD on behalf of the REPAIR investigators
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Zusammenfassung:BACKGROUND: - Residual mitral regurgitation (rMR) ≤1+ has been associated with improved 1-year outcomes after mitral valve transcatheter edge-to-edge repair, regardless of the mean mitral pressure gradient (MPG). Prior evidence is limited to 30-day echocardiographic follow-up and patients treated with the MitraClip (Abbott Structural Heart). Whether rMR and MPG assessed at discharge are associated with outcomes after PASCAL mitral valve transcatheter edge-to-edge repair (Edwards Lifesciences) remains unknown. - METHODS: - REPAIR (Registry of Pascal for Mitral Regurgitation) is an investigator-initiated, multicenter registry including all consecutive patients treated with PASCAL mitral valve transcatheter edge-to-edge repair. Based on discharge echocardiography, patients were stratified into 4 groups: optimal (rMR ≤1+, MPG <5 mm Hg), MPG-suboptimal (rMR ≤1+, MPG ≥5 mm Hg), rMR-suboptimal (rMR ≥2+, MPG <5 mm Hg), and dual-suboptimal (rMR ≥2+, MPG ≥5 mm Hg). The primary end point was 1-year mortality. - RESULTS: - Among 2172 patients (median follow-up, 463 days [Q1-Q3, 357-815]), 59.4% were classified as optimal, 12.2% MPG-suboptimal, 21.3% rMR-suboptimal, and 7.0% dual-suboptimal. One-year mortality differed significantly across groups (P<0.001), with the lowest rate in the optimal (8.7% [95% CI, 6.8%-10.5%]) and highest in the dual-suboptimal group (20.1% [95% CI, 12.0%-27.4%]; PBonferroni <0.001). rMR ≤1+ was associated with lower 1-year mortality (hazard ratio, 0.54 [95% CI, 0.37-0.74]; P<0.001) and remained significant, independent of dichotomized (MPG, <5 versus ≥5 mm Hg) or continuous MPG. Dichotomized MPG was not significantly associated with 1-year mortality (hazard ratio, 0.73 [95% CI, 0.51-1.04]; P=0.078), whereas continuous MPG was (hazard ratio per mm Hg increase, 1.10 [95% CI, 1.00-1.21]; P=0.048) with a trend after adjusting for rMR ≤1+ (adjusted hazard ratio per mm Hg increase, 1.07 [95% CI, 0.98-1.18]; P=0.145). No interaction was observed between rMR ≤1+ and dichotomized/continuous MPG (both Pinteraction >0.450). - CONCLUSIONS: - Discharge rMR ≤1+ is independently associated with lower 1-year mortality after PASCAL mitral valve transcatheter edge-to-edge repair. Although MPG was not independently associated, modestly elevated gradients may be acceptable when rMR ≤1+ is achieved, but should still warrant clinical attention. - REGISTRATION: - URL: https://www.drks.de; Unique identifier: DRKS00033959.
Beschreibung:Gesehen am 20.04.2026
Beschreibung:Online Resource
ISSN:1941-7632
DOI:10.1161/CIRCINTERVENTIONS.125.015845

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