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Repeat Mitral Transcatheter Edge-to-Edge Repair for Recurrent Significant Mitral Regurgitation
Alon Shechter1,2,3, Mirae Lee1,4, Danon Kaewkes1,5
1Department of Cardiology Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA USA.
Journal of the American Heart Association
|April 29, 2023
Summary
Repeat mitral transcatheter edge-to-edge repair is feasible and safe for recurrent mitral regurgitation (MR). Outcomes are comparable to first-time procedures, particularly in patients without significant tricuspid regurgitation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Limited data exist on repeat mitral transcatheter edge-to-edge repair (MTR) for recurrent significant mitral regurgitation (MR).
- Understanding outcomes of second MTR procedures is crucial for managing complex cardiac cases.
Purpose of the Study:
- To evaluate the feasibility, safety, and clinical effectiveness of repeat MTR in patients with recurrent significant MR.
- To identify predictors of outcomes following a second MTR procedure.
Main Methods:
- Retrospective analysis of 52 patients undergoing a second MTR after a successful first procedure.
- Assessment of clinical, laboratory, and echocardiographic data up to 1 year post-intervention.
- Primary outcome: composite of all-cause death or heart failure (HF) hospitalizations.
Main Results:
- All repeat MTR procedures were technically successful.
- At 1 year, 96% of patients showed improved MR severity or functional class, though improvements were modest.
- 1-year outcomes were comparable to patients undergoing a single MTR.
- Significant tricuspid regurgitation was the sole independent predictor of adverse outcomes.
Conclusions:
- Repeat MTR is a feasible, safe, and clinically effective option for recurrent MR.
- Effectiveness is particularly noted in non-functional MR patients without significant tricuspid regurgitation.
- Careful patient selection, considering baseline tricuspid regurgitation, is essential for optimal results.
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