Impact of Left Atrial v-Wave Following Mitral Edge-to-Edge Repair on Survival: The MITRA-PRO Registry

Transcatheter edge-to-edge repair (TEER) for mitral regurgitation has been shown to affect left atrial pressure (LAP). However, the prognostic significance of postprocedural LAP changes remains a matter of debate. We aimed to evaluate the impact of v-wave on long-term survival after TEER.

A total of 1487 patients in the large-scale, multicenter MITRA-PRO (MITRAclip PROgnosis) registry with post-mitral TEER v-wave assessment were included in this study.

After 3-years, survival was significantly reduced in patients with increased v-wave after mitral TEER, while patients with decreased v-wave showed the lowest 3-year mortality. A receiver operating characteristic analysis revealed a postprocedural v-wave >25 mm Hg as a relevant predictor of 3-year mortality following mitral TEER. Three-year mortality was significantly lower in patients with a v-wave ≤25 mm Hg indicating a postprocedural v-wave >25 mm Hg as a negative predictor of long-term survival (v-wave ≤25 mm Hg group: 34.2% versus v-wave >25 mm Hg group: 46.8%; P<0.001). Furthermore, 3-year functional outcome assessed by New York Heart Association classification was significantly better in patients with v-wave ≤25 mm Hg (v-wave ≤25 mm Hg: New York Heart Association I: 10.4%, II: 51.2, III: 33.2%, and IV: 5.3% versus v-wave >25 mm Hg: New York Heart Association I: 11.3%, II: 32.3, III: 47.6%, and IV: 8.9%; P=0.003). In both, functional and degenerative mitral regurgitation 3-year mortality was significantly higher in the v-wave >25 mm Hg group.

A postprocedural v-wave >25 mm Hg is linked to reduced long-term survival. Multimodal residual mitral regurgitation assessment including v-wave supports the interventionalist in TEER guidance and optimizing procedural results aiming for decreasing v-wave to <25 mm Hg.

URL: https://drks.de/search/en/trial/DRKS00012288; German Clinical Trials Register identifier: DRKS00012288.