Impact of Asymmetric Tethering on Outcomes After Edge-to-edge Mitral Valve Repair for Secondary Mitral Regurgitation

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2021 Nov 17

PMID 34786592

Citations 3

Authors

Lukas Stolz

Mathias Orban

Daniel Braun

Philipp Doldi

Martin Orban

Konstantin Stark

Michael Mehr

Julius Steffen

Kornelia Low

Christian Hagl

Steffen Massberg

Michael Nabauer

Jorg Hausleiter

Affiliations

Soon will be listed here.

Abstract

Background: The impact of postero-anterior and medio-lateral mitral valve (MV) tethering patterns on outcomes in patients undergoing transcatheter edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR) is unknown.

Methods: The ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in MV segment 2 was defined as postero-anterior tethering asymmetry. Medio-lateral tethering asymmetry was assessed as the ratio of the medial (segment 3) to lateral (segment 1) MV tenting area. We used receiver-operating characteristics and a Cox regression model to identify cut-off values of asymmetric anteroposterior and medio-lateral tethering for prediction of 2 year all-cause mortality after TMVR.

Results: Among 178 SMR patients, postero-anterior tethering was asymmetric in 67 patients (37.9%, PLA/ALA ratio > 1.54). Asymmetric medio-lateral tethering (tenting area ratio > 1.49) was observed in 49 patients (27.5%). M-TEER reduced MR to ≤ 2 + in 92.1% of patients; MR reduction was less effective in the presence of asymmetric postero-anterior tethering (p = 0.02). A multivariable Cox regression model identified both types of asymmetric MV tethering to be associated with increased all-cause 2-year mortality (postero-anterior tethering asymmetry: HR = 2.77, CI 1.43-5.38; medio-lateral tethering asymmetry: HR = 2.90, CI 1.54-5.45; p < 0.01).

Conclusions: Asymmetric postero-anterior and medio-lateral MV tethering patterns are associated with increased 2-year mortality in patients undergoing M-TEER for SMR. A detailed echocardiographic analysis of MV anatomy may help to identify patients who profit most from M-TEER.

Citing Articles

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Hausleiter J, Stocker T, Adamo M, Karam N, Swaans M, Praz F EuroIntervention. 2023; 18(12):957-976.

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