Implications of Mitral Annular Disjunction in Patients Undergoing Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation.

MitraClip mitral annular disjunction mitral regurgitation mitral transcatheter edge-to-edge repair transcatheter mitral valve repair

Journal

JACC. Cardiovascular interventions
ISSN: 1876-7605
Titre abrégé: JACC Cardiovasc Interv
Pays: United States
ID NLM: 101467004

Informations de publication

Date de publication:
11 Dec 2023
Historique:
received: 19 07 2023
revised: 02 10 2023
accepted: 10 10 2023
medline: 14 12 2023
pubmed: 14 12 2023
entrez: 13 12 2023
Statut: ppublish

Résumé

Little is known about mitral transcatheter edge-to-edge repair (TEER) in patients with mitral annular disjunction (MAD). The authors sought to explore TEER for degenerative mitral regurgitation (MR) according to MAD status. We retrospectively analyzed 271 consecutive patients (median age 82 [Q1-Q3: 75-88] years, 60.9% men) undergoing an isolated, first-ever TEER for whom there were viewable preprocedural echocardiograms. Stratified by MAD status at baseline, the cohort was evaluated for all-cause mortality, heart failure hospitalizations, and mitral reinterventions-the composite of which constituted the primary outcome-as well as functional capacity and residual MR, all along the first postprocedural year. Individuals with (n = 62, 22.9%) vs without MAD had more extensive prolapse and larger valve dimensions. Although the former's procedures were longer, utilizing more devices per case, technical success rate and residual MR were comparable. MAD presence was associated with higher mortality risk (HR: 2.64; 95% CI: 1.82-5.52; P = 0.014), and increased MAD length-with lower odds of functional class ≤II (OR: 0.65; 95% CI: 0.47-0.88; P = 0.006). Among 47 MAD patients with retrievable 1-month data, MAD regressed in 91.5% and by an overall 50% (Q1-Q3: 22%-100%) compared with baseline (P < 0.001). A greater MAD shortening conferred attenuated risk for the primary outcome. In our experience, TEER for degenerative MR accompanied by MAD was feasible and safe; however, its postprocedural course was somewhat less favorable. MAD shortening following TEER was observed in most patients and proved prognostically beneficial.

Sections du résumé

BACKGROUND BACKGROUND
Little is known about mitral transcatheter edge-to-edge repair (TEER) in patients with mitral annular disjunction (MAD).
OBJECTIVES OBJECTIVE
The authors sought to explore TEER for degenerative mitral regurgitation (MR) according to MAD status.
METHODS METHODS
We retrospectively analyzed 271 consecutive patients (median age 82 [Q1-Q3: 75-88] years, 60.9% men) undergoing an isolated, first-ever TEER for whom there were viewable preprocedural echocardiograms. Stratified by MAD status at baseline, the cohort was evaluated for all-cause mortality, heart failure hospitalizations, and mitral reinterventions-the composite of which constituted the primary outcome-as well as functional capacity and residual MR, all along the first postprocedural year.
RESULTS RESULTS
Individuals with (n = 62, 22.9%) vs without MAD had more extensive prolapse and larger valve dimensions. Although the former's procedures were longer, utilizing more devices per case, technical success rate and residual MR were comparable. MAD presence was associated with higher mortality risk (HR: 2.64; 95% CI: 1.82-5.52; P = 0.014), and increased MAD length-with lower odds of functional class ≤II (OR: 0.65; 95% CI: 0.47-0.88; P = 0.006). Among 47 MAD patients with retrievable 1-month data, MAD regressed in 91.5% and by an overall 50% (Q1-Q3: 22%-100%) compared with baseline (P < 0.001). A greater MAD shortening conferred attenuated risk for the primary outcome.
CONCLUSIONS CONCLUSIONS
In our experience, TEER for degenerative MR accompanied by MAD was feasible and safe; however, its postprocedural course was somewhat less favorable. MAD shortening following TEER was observed in most patients and proved prognostically beneficial.

Identifiants

DOI: 10.1016/j.jcin.2023.10.012 PMID: 38092492
pubmed: 38092492
pii: S1936-8798(23)01373-0
doi: 10.1016/j.jcin.2023.10.012
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

2835-2849

Informations de copyright

Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Funding Support and Author Disclosures Dr Chakravarty is a consultant for Edwards Lifesciences, Abbott Lifesciences, Boston Scientific, and Medtronic; is a speaker for Edwards Lifesciences, Boston Scientific, and Medtronic; and is a proctor for Edwards Lifesciences and Medtronic. Dr Makkar has received grant support from Edwards Lifesciences Corporation; is a consultant for Abbott Vascular, Cordis, and Medtronic; and holds equity in Entourage Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Auteurs

Alon Shechter (A)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Mordehay Vaturi (M)

Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Gloria J Hong (GJ)

Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Danon Kaewkes (D)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Vivek Patel (V)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Minji Seok (M)

Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Takashi Nagasaka (T)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.

Ofir Koren (O)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.

Keita Koseki (K)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.

Sabah Skaf (S)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Moody Makar (M)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Tarun Chakravarty (T)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Raj R Makkar (RR)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. Electronic address: Raj.Makkar@cshs.org.

Robert J Siegel (RJ)

Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA. Electronic address: Robert.Siegel@cshs.org.

Classifications MeSH