Transcatheter Edge-to-Edge Repair for Atrial Secondary Mitral Regurgitation

BACKGROUND Atrial secondary mitral regurgitation (ASMR) is a subtype of SMR that has a poor prognosis, and thus far, evidence of the therapeutic options for the management of ASMR is limited. OBJECTIVES This study aimed to investigate the effectiveness of transcatheter edge-to-edge repair (TEER) for ASMR. METHODS The study retrospectively analyzed consecutive patients who underwent MitraClip at the Heart Center Bonn. ASMR was defined as cases that met all of the following criteria: 1) normal mitral leaflets without organic disorder; 2) left ventricular ejection fraction >50%; and 3) absence of LV enlargement and segmental abnormality. The primary outcome measure was MR reduction to <= 1+, and its predictors were explored in a logistic regression analysis. RESULTS Among 415 patients with SMR, 118 patients met the criteria for ASMR (mean age 80 +/- 8 years, 39.8% male). The technical success rate was 94.1%, and MR reduction to <= 1+ after TEER was achieved in 94 (79.7%) patients with ASMR. The in-hospital mortality rate was 2.5%. In multivariable logistic analysis, a large left atrial volume index and low leaflet-to-annulus index were associated with a lower incidence of MR reduction to <= 1+ after TEER for ASMR. In addition, the use of a newer generation of the MitraClip systems (NTR/XTR or G4 systems) was associated with a higher incidence of MR reduction to <= 1+. CONCLUSIONS TEER is a safe and feasible therapeutic option for patients with ASMR. Assessments of left atrial volume index and leaflet-to-annulus index may assist with patient selection for TEER in patients with ASMR. (c) 2022 Published by Elsevier on behalf of the American College of Cardiology Foundation.