Impact of Eccentric Residual Mitral Regurgitation on Long-Term Survival After Transcatheter Edge-to-Edge Mitral Valve...

More than mild residual mitral regurgitation (MR) is associated with reduced survival after transcatheter edge-to-edge mitral valve repair (M-TEER). However, whether the morphology of the residual MR (rMR) jet affects long-term clinical outcomes has not been reported. The purpose of the study was to assess the impact of eccentric rMR (erMR) at discharge on long-term mortality and heart failure hospitalizations after M-TEER.

We analyzed preprocedural, intraprocedural, and early postprocedural echocardiographic data (1-2 days post-TEER) in patients treated by M-TEER at our institution between 2012 and 2022. Eccentric rMR was defined as a nonsymmetric, wall-hugging MR jet.

Among 125 patients with early residual jets, erMR was present in 30% and more commonly in those with medially placed devices and in severe rMR (p < 0.05). Eccentric jets were equally frequent in patients with originally functional or degenerative MR. During 49 (26-79) months follow-up, the median survival was 29 months in patients with erMR vs. 65 months in patients without erMR (p < 0.001). In Cox regression analysis, erMR predicted a 2.2-fold higher risk of death (95% CI 1.3-3.7, p < 0.05) after adjustment for MR severity, age, mean blood pressure, atrial fibrillation, left ventricular and left atrial size, and device position. Eccentric rMR also predicted a 1.8-fold (95% CI 1.1-3.1, p = 0.02) higher adjusted risk of heart failure hospitalization post-M-TEER.

Presence of erMR at discharge is associated with reduced long-term survival after M-TEER independent of the severity of rMR. Our findings shed light on the importance of preprocedural and intraprocedural planning to avoid eccentric jets and mitigate unfavorable long-term outcomes after M-TEER.