Transcatheter Mitral Valve Repair for Multiple Valvular Heart Disease: Outcomes and Insights on Combined Aortic Insufficiency and Mitral Regurgitation.

The presence of concomitant aortic insufficiency (AI) and mitral regurgitation (MR) is common and may further accelerate cardiac dysfunction. However, there exists no United States regulatory approved transcatheter device for the treatment AI. The effectiveness of isolated transcatheter mitral therapy in this population is not well understood, thus we aimed to evaluate outcomes for patients with combined AI and MR in comparison to isolated MR that underwent mitral transcatheter edge-to-edge repair (m-TEER). Retrospective data were obtained from Northwell m-TEER registry. A total of 587 patients that underwent m-TEER at four high volume TAVR/TEER centers within the Northwell Health system were included. All patients had severe MR and were divided into two groups: Group 1 with ≥ 3+ AI (AI+) and the Group 2 with <3+ AI (AI-). Echocardiographic outcomes were evaluated at 1 month. Clinical outcomes were evaluated at one month and 1 year. The primary endpoint was death or re-hospitalization at 1 year. 587 patients were included in the study, 92 in the AI+ group. Baseline characteristics were similar in both groups. Approximately two-thirds of patients in the AI+ group demonstrated an improvement in AI severity after isolated mitral therapy. There was no difference in the primary outcome at 1 month or 1 year. There was also no significant difference in NYHA functional class at 1 month between groups. In conclusion, patients that underwent m-TEER with combined MR and AI (AI+) fared well in comparison to isolated mitral valve dysfunction (AI-), with no discernible differences in survival, NYHA class, or re-hospitalization rates at 1 month or 1 year. Hence, isolated m-TEER is a reasonable treatment approach in patients with a high surgical risk with combined AI and MR.

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Copyright © 2024. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Chad Kliger reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory and speaking and lecture fees. Bruce Rutkin reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory and speaking and lecture fees. Chad Kliger reports a relationship with Medtronic Inc that includes: consulting or advisory and speaking and lecture fees. Bruce Rutkin reports a relationship with Medtronic Inc that includes: consulting or advisory and speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.