Relation of Residual Mitral Regurgitation and Gradient Following Mitral Valve Transcatheter Edge-to-Edge Repair.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Mustafa Donika, von Stein Jennifer, Stolz Lukas, Haurand Jean Marc, Gröger Matthias, Rudolph Felix, Jobst Jannik, Mues Christoph Alexander, Mahabadi Amir Abbas, Hoerbrand Isabel A, Schulz Carl, Sugiura Atsushi, Lurz Philipp, Kister Tobias, Sagmeister Paula, Wolff Charlotte, Gerçek Muhammed, Horn Patrick, Kessler Mirjam, Ascione Guido, Rassaf Tienush, Weber Marcel, Schofer Niklas, Konstandin Mathias H, Schindhelm Florian, Möllmann Helge, Unsöld Bernhard, Guthoff Henning, Baldus Stephan, Rottbauer Wolfgang, Rudolph Volker, Granada Juan F, Hausleiter Jörg, Pfister Roman, Mauri Victor, von Stein Philipp, REPAIR investigators
Аннотация
METHODS: REPAIR (Registry of Pascal for Mitral Regurgitation) is an investigator-initiated, multicenter registry including all consecutive patients treated with PASCAL mitral valve transcatheter edge-to-edge repair. Based on discharge echocardiography, patients were stratified into 4 groups: optimal (rMR ≤1+, MPG <5 mm Hg), MPG-suboptimal (rMR ≤1+, MPG ≥5 mm Hg), rMR-suboptimal (rMR ≥2+, MPG <5 mm Hg), and dual-suboptimal (rMR ≥2+, MPG ≥5 mm Hg). The primary end point was 1-year mortality.
RESULTS: Among 2172 patients (median follow-up, 463 days [Q1-Q3, 357-815]), 59.4% were classified as optimal, 12.2% MPG-suboptimal, 21.3% rMR-suboptimal, and 7.0% dual-suboptimal. One-year mortality differed significantly across groups (P<0.001), with the lowest rate in the optimal (8.7% [95% CI, 6.8%-10.5%]) and highest in the dual-suboptimal group (20.1% [95% CI, 12.0%-27.4%]; PBonferroni <0.001). rMR ≤1+ was associated with lower 1-year mortality (hazard ratio, 0.54 [95% CI, 0.37-0.74]; P<0.001) and remained significant, independent of dichotomized (MPG, <5 versus ≥5 mm Hg) or continuous MPG. Dichotomized MPG was not significantly associated with 1-year mortality (hazard ratio, 0.73 [95% CI, 0.51-1.04]; P=0.078), whereas continuous MPG was (hazard ratio per mm Hg increase, 1.10 [95% CI, 1.00-1.21]; P=0.048) with a trend after adjusting for rMR ≤1+ (adjusted hazard ratio per mm Hg increase, 1.07 [95% CI, 0.98-1.18]; P=0.145). No interaction was observed between rMR ≤1+ and dichotomized/continuous MPG (both Pinteraction >0.450).
CONCLUSIONS: Discharge rMR ≤1+ is independently associated with lower 1-year mortality after PASCAL mitral valve transcatheter edge-to-edge repair. Although MPG was not independently associated, modestly elevated gradients may be acceptable when rMR ≤1+ is achieved, but should still warrant clinical attention.
REGISTRATION: URL: https://www.drks.de; Unique identifier: DRKS00033959.