TY - JOUR
T1 - Association of Baseline Mitral Valve Area With Procedural and Clinical Outcomes of Mitral Transcatheter Edge-to-Edge Repair
T2 - Insights From the OCEAN-Mitral Registry
AU - Mushiake, Kazunori
AU - Kubo, Shunsuke
AU - Ono, Sachiyo
AU - Maruo, Takeshi
AU - Nishiura, Naoki
AU - Osakada, Kohei
AU - Kadota, Kazushige
AU - Yamamoto, Masanori
AU - Saji, Mike
AU - Asami, Masahiko
AU - Enta, Yusuke
AU - Nakashima, Masaki
AU - Shirai, Shinichi
AU - Izumo, Masaki
AU - Mizuno, Shingo
AU - Watanabe, Yusuke
AU - Amaki, Makoto
AU - Kodama, Kazuhisa
AU - Yamaguchi, Junichi
AU - Izumi, Yuki
AU - Naganuma, Toru
AU - Bota, Hiroki
AU - Ohno, Yohei
AU - Yamawaki, Masahiro
AU - Ueno, Hiroshi
AU - Mizutani, Kazuki
AU - Otsuka, Toshiaki
AU - Hayashida, Kentaro
N1 - Publisher Copyright:
© 2024 American Heart Association, Inc.
PY - 2024/12/1
Y1 - 2024/12/1
N2 - BACKGROUND: A small mitral valve area (MVA) is one of the challenging anatomies for transcatheter edge-to-edge repair (TEER) for mitral regurgitation, but the relationship between baseline MVA and clinical outcomes remains unknown. This study aimed to evaluate the association of baseline MVA with procedural and clinical outcomes in patients undergoing TEER with MitraClip from the OCEAN-Mitral registry (Optimized Catheter Valvular Intervention-Mitral). METHODS: A total of 1768 patients undergoing TEER were divided into 3 groups according to baseline MVA: group 1: <4.0 cm2, n=358; group 2: 4.0-5.0 cm2, n=493; and group 3: ≥5.0 cm2, n=917. The primary end point was a composite of all-cause death and heart failure hospitalization within 2 years of TEER and compared between the 3 groups. RESULTS: Patients with smaller MVA had significantly fewer clips implanted and higher postprocedural transmitral mean pressure gradient. There was no significant difference in the acute procedural success rate and postprocedural mitral regurgitation severity between the 3 groups. The incidence of the primary end point was similar in group 1 compared with groups 2 and 3 (35.2% versus 34.5% versus 34.0%; P=0.96) and was also similar in patients with MVA <3.5 cm2 and those with MVA 3.5 to 4.0 cm2. The adjusted risk of MVA <4.0 cm2 relative to MVA of 4.0 to 5.0 cm2 and MVA ≥5 cm2 for the primary end point remained insignificant (hazard ratio, 1.06 [95% CI, 0.79-1.41]; P=0.68; hazard ratio, 0.99 [95% CI, 0.75-1.31]; P=0.96, respectively). At 1 year, no significant difference in the proportion of residual mitral regurgitation 3+/4+ was observed between the 3 groups (7.2% versus 4.4% versus 6.5%; P=0.49). CONCLUSIONS: In patients undergoing TEER, a small MVA <4.0 cm2 may limit the number of clips implanted and increase the transmitral pressure gradient after TEER, but baseline MVA was not associated with mitral regurgitation reduction and clinical outcomes.
AB - BACKGROUND: A small mitral valve area (MVA) is one of the challenging anatomies for transcatheter edge-to-edge repair (TEER) for mitral regurgitation, but the relationship between baseline MVA and clinical outcomes remains unknown. This study aimed to evaluate the association of baseline MVA with procedural and clinical outcomes in patients undergoing TEER with MitraClip from the OCEAN-Mitral registry (Optimized Catheter Valvular Intervention-Mitral). METHODS: A total of 1768 patients undergoing TEER were divided into 3 groups according to baseline MVA: group 1: <4.0 cm2, n=358; group 2: 4.0-5.0 cm2, n=493; and group 3: ≥5.0 cm2, n=917. The primary end point was a composite of all-cause death and heart failure hospitalization within 2 years of TEER and compared between the 3 groups. RESULTS: Patients with smaller MVA had significantly fewer clips implanted and higher postprocedural transmitral mean pressure gradient. There was no significant difference in the acute procedural success rate and postprocedural mitral regurgitation severity between the 3 groups. The incidence of the primary end point was similar in group 1 compared with groups 2 and 3 (35.2% versus 34.5% versus 34.0%; P=0.96) and was also similar in patients with MVA <3.5 cm2 and those with MVA 3.5 to 4.0 cm2. The adjusted risk of MVA <4.0 cm2 relative to MVA of 4.0 to 5.0 cm2 and MVA ≥5 cm2 for the primary end point remained insignificant (hazard ratio, 1.06 [95% CI, 0.79-1.41]; P=0.68; hazard ratio, 0.99 [95% CI, 0.75-1.31]; P=0.96, respectively). At 1 year, no significant difference in the proportion of residual mitral regurgitation 3+/4+ was observed between the 3 groups (7.2% versus 4.4% versus 6.5%; P=0.49). CONCLUSIONS: In patients undergoing TEER, a small MVA <4.0 cm2 may limit the number of clips implanted and increase the transmitral pressure gradient after TEER, but baseline MVA was not associated with mitral regurgitation reduction and clinical outcomes.
KW - catheters
KW - heart failure
KW - incidence
KW - mitral valve
KW - mitral valve insufficiency
UR - http://www.scopus.com/inward/record.url?scp=85212257291&partnerID=8YFLogxK
U2 - 10.1161/CIRCINTERVENTIONS.124.014420
DO - 10.1161/CIRCINTERVENTIONS.124.014420
M3 - 学術論文
C2 - 39689186
AN - SCOPUS:85212257291
SN - 1941-7640
VL - 17
SP - e014420
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 12
ER -