Quantitative Three-Dimensional Transesophageal Echocardiography Analysis of Mitral Valve Geometry for Transcatheter...

Atrial functional mitral regurgitation (AFMR) is a distinct subtype of secondary mitral regurgitation (MR) in patients with atrial fibrillation (AF). Although mitral transcatheter edge-to-edge repair (M-TEER) is increasingly performed under three-dimensional (3D) transesophageal echocardiography (TEE) guidance, detailed characterization of 3D mitral valve geometry relevant to procedural strategy remains limited.

To investigate the impact of mitral valve geometrical parameters on preprocedural planning and outcomes of M-TEER in AFMR.

Patients with AFMR undergoing M-TEER with analyzable intraprocedural 3D TEE data were retrospectively enrolled. We evaluated whether the total leaflet area to mitral annulus area ratio (TLA/MAA) was associated with procedural strategy (1 vs 2 devices) and procedural failure, defined as residual MR ≥ 2+ and/or postprocedural transmitral mean pressure gradient (MPG) ≥ 5 mm Hg.

Among 130 patients (mean age, 78.1 years; 60.8% male; 93.4% AF), residual MR ≥ 2+ occurred in 31 patients and post-M-TEER MPG ≥ 5 mm Hg in 35 patients. Thirty patients received 2 devices. Lower TLA/MAA was associated with residual MR ≥ 2+, use of 2 devices, and postprocedural MPG ≥ 5 mm Hg. Under the composite definition of procedural success (MR < 2+ and MPG < 5 mm Hg), TLA/MAA outperformed MAA in predicting success with 1 device (area under the curve = 0.79 vs 0.53; P < .001).

In AFMR, 3D TEE-derived TLA/MAA can provide geometrical information to guide preprocedural M-TEER strategy to balance MR reduction and transmitral gradient.