During transcatheter edge-to-edge repair (TEER), the reduction of functional mitral
regurgitation (FMR) severity, compared with baseline evaluation, is not uncommon.
Because the procedural strategies are mainly guided by the location and severity of
the regurgitant jets, intraprocedural downgrading (ID) of regurgitation severity could
affect the procedural strategy and the results. The aim of this study was to evaluate
the prevalence of ID during TEER and to compare early and midterm outcomes in patients
with and without ID. All patients with moderate-to-severe or severe FMR who underwent
TEER in San Raffaele Hospital between 2018 and 2020 were evaluated in this single-center,
retrospective study. ID was defined as mild (1+) or moderate (2+) regurgitation degree
during intraprocedural evaluation. The outcomes, assessed at discharge and at 2 years
of follow-up, were all-cause mortality, heart failure hospitalization, and recurrence
of mitral regurgitation >2+. The final study cohort included 55 patients: 42% presented
with ID. At discharge, 85.5% of patients achieved regurgitation reduction to 2+ or
less: 100% in patients with ID versus 75% in patients without ID, p <0.009. At 2 years,
no significant difference in the incidence of all-cause mortality, heart failure hospitalization,
and the recurrence of mitral regurgitation >2+ between patients with ID or without
ID was found. In conclusion, ID is frequent during TEER in FMR. No baseline characteristics
were found to identify this group of patients. In patients with ID, the combination
of live intraprocedural imaging and baseline ambulatory assessment of regurgitant
jets seems effective in the procedural guiding to achieve a successful and durable
mitral repair.
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Article info
Publication history
Published online: December 20, 2022
Received in revised form:
October 23,
2022
Received:
July 29,
2022
Footnotes
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Identification
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© 2022 Elsevier Inc. All rights reserved.
