Prognostic Value of Increased Mitral Valve Gradient after Transcatheter Edge-to-Edge Repair for Primary Mitral Regurgitation.

OBJECTIVES This study sought to evaluate the prognostic value of an increased mean mitral valve pressure gradient (MVG) in patients with primary mitral regurgitation (MR) after transcatheter edge-to-edge repair (TEER). BACKGROUND Conflicting data exist regarding impact of increased mean MVG on outcomes after TEER. METHODS This study included 419 patients with primary MR (mean age 80.6 +/- 10.4 years; 40.6% female) who underwent TEER. Patients were divided into quartiles (Qs) based on discharge echocardiographic mean MVG. Primary outcome was the composite endpoint of all-cause mortality and heart failure hospitalization. Secondary outcomes included all-cause mortality and the secondary composite endpoint of all-cause mortality, heart failure hospitalization, and mitral valve reintervention. RESULTS The median number of MitraClips used was 2 per patient. MR reduction <= moderate was achieved in 407 (97.1%) patients. Mean MVG was 1.9 +/- 0.3 mm Hg, 3.0 +/- 0.1 mm Hg, 4.0 +/- 0.1 mm Hg, and 6.0 +/- 1.2 mm Hg in Q1, Q2, Q3, and Q4, respectively. There was no significant differences across quartiles in the primary outcome (15.4%, 19.6%, 22.0%, and 21.9% in Q1-Q4, respectively; P = 0.63), all-cause mortality (15.9% vs 18.6% vs 19.4% vs 17.1%, respectively; P = 0.91), and the secondary composite endpoint at 2 years (33.3% vs 29.5% vs 22.0% vs 31.6%, respectively; P = 0.37). After multivariate adjustment for baseline clinical and procedural variables, the mean MVG in Q4 compared with Q1 to Q3 was not independently associated with the primary outcome (HR: 1.22; 95% CI: 0.82-1.83; P = 0.33), allcause mortality, and the secondary composite endpoint. CONCLUSIONS Increased mean MVG was not independently associated with adverse events after TEER in patients with primary MR. (C) 2022 by the American College of Cardiology Foundation.