LAUSR

Percutaneous edge-to-edge mitral repair is a safe treatment method for functional (FMR) and degenerative (DMR) mitral regurgitation. Iatrogenic mitral stenosis remains a concern and periprocedural transoesophageal echocardiography is essential for real-time monitoring of mean mitral pressure gradient (intra-MMPG) and to guide clip deployment. Published data suggests intra-MMPG predicts clinical outcome and mortality only in DMR patients. We sought to validate these findings in a large high-volume UK center cohort with prolonged follow-up and further explore its use to predict mortality in functional MR patients. All consecutive patients who underwent edge-to-edge mitral repair between 2010 and 2020 were analysed. The intra-MMPG and the severity of MR grade from the transoesophageal echocardiogram post-clip deployment (intra-MRgrade) were collected. Statistical analysis using covariates before and after edge-to-edge repair were compared using paired tests and cox regression models were used to assess the relationship of covariates with all-cause mortality. p<0.05 was deemed as statistically significant. We analysed data from 246 consecutive patients, 65% were men and mean age was 76±11 years. Pre-procedure LVEF was 49±15%, TAPSE was 16±6 mm, severity of MR was 3.8±0.5, 80% had NYHA III/IV and 45% had FMR. Post procedure, there was a significant reduction in severity of MR grade (3.8±0.5 to 1.7±0.8; p<0.001) and a reduction in LVEF (49±15 to 45±15%; p<0.001). There were significant improvements in NYHA class (3.2±0.6 to 2.0±0.6; P<0.0001) and LV outflow tract VTI (15±5 to 17±4 cm; p<0.001). Patients were followed-up for a median of 1021 days (inter-quartile range 289 to 1555) during which 76 patients died. Multivariate survival analysis (see table) showed that the increase in intra-MMPG was independently associated with mortality for FMR, but not for DMR. Furthermore, higher intra-MRgrade was associated with mortality for FMR patients only. Intraprocedural mean mitral pressure gradient (intra-MMPG) predicts mortality in percutaneous mitral edge-to-edge repair for FMR, but not for DMR, herby challenging previously published data. Type of funding source: None