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Updated: Jun 24, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Transmitral Pressure Gradient and Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair in Patients
Yuki Gonda1, Masahiko Asami1, Yu Horiuchi1
1Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Abstract:
Patients undergoing hemodialysis (HD) have poor outcomes after transcatheter edge-to-edge repair (TEER). However, the prognostic significance of postprocedural transmitral pressure gradient (TMPG) and residual mitral regurgitation (MR) in this population remains unclear. In the prospective, multicenter Optimized CathEter vAlvular iNtervention (OCEAN)-Mitral registry, we analyzed 3,515 patients with immediate postprocedural TMPG and MR data, including 224 (6.4%) on HD and 3,291 (93.6%) not on HD. The primary outcome was all-cause mortality at 2 years. During a median follow-up of 434 days, 624 deaths (17.8%) occurred. All-cause mortality was significantly higher in HD patients than in non-HD patients (33.0% vs 16.7%, p <0.001). Noncardiovascular death accounted for a greater proportion of deaths in HD patients than in non-HD patients (17.9% vs 6.6%, p <0.001). In non-HD patients, a postprocedural TMPG ≥5 mm Hg was associated with increased mortality (adjusted hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.18 to 2.03, p = 0.002), whereas this association was not statistically significant in HD patients (adjusted HR 1.68, 95% CI 0.83 to 3.38, p = 0.147). Similarly, residual MR ≥2+ was associated with higher mortality in non-HD patients (adjusted HR 1.26, 95% CI 1.01 to 1.58, p = 0.043), whereas no statistically significant association was demonstrated in HD patients (adjusted HR 1.47, 95% CI 0.70 to 3.08, p = 0.307). In conclusion, elevated postprocedural TMPG and residual MR were associated with higher mortality in non-HD patients, whereas no statistically robust associations were demonstrated in HD patients.
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