Early Transcatheter Edge-to-Edge Repair is Associated with Improved Mid-term Outcomes in Degenerative Mitral Regurgitation.

Abstract

Current guidelines offer limited guidance on the optimal timing of mitral transcatheter edge-to-edge repair (M-TEER) in degenerative mitral regurgitation (DMR). We evaluated whether the interval between diagnosis of DMR with heart failure (HF) and M-TEER was associated with clinical outcomes. We analyzed 1,061 patients with DMR who underwent M-TEER, stratified by timing: early group (n=667, ≤1 year after DMR-HF diagnosis) versus delayed group (n=394, >1 year after DMR-HF diagnosis). Echocardiographic markers of cardiac damage were compared. Outcomes were all-cause mortality, the composite of mortality and HF hospitalization, and changes in HF hospitalization and New York Heart Association (NYHA) class III/IV symptoms. The early group had less cardiac damage (higher ejection fraction, smaller left ventricular dimensions and left atrial volume index) and lower rates of atrial fibrillation and severe tricuspid regurgitation (all P<0.05). At 3 years, mortality (25.1% vs 32.7%, P=0.013) and the composite endpoint (34.1% vs 45.8%, P=0.015) were lower in the early group. Earlier intervention was independently associated with lower risks of mortality (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.52-0.95, P=0.020) and the composite endpoint (HR 0.70, 95% CI 0.54-0.89, P=0.004). Within 1 year, HF hospitalization fell from 71.8% to 7.0% (early group) and 62.2% to 8.4% (delayed group), and NYHA class III/IV symptoms from 58.6% to 3.3% and 61.7% to 4.0%, respectively. In conclusion, in patients with DMR and HF, earlier M-TEER was associated with lower mortality and fewer adverse events, although causality cannot be inferred. Both groups showed reductions in HF hospitalizations and improved symptoms.