Mitral Transcatheter Edge-to-Edge Repair in Symptomatic Hypertrophic Cardiomyopathy: A Systematic Review.

BACKGROUND

Hypertrophic cardiomyopathy (HCM) with left ventricular outflow tract (LVOT) obstruction poses significant clinical challenges. Although septal reduction therapy (SRT) is the first treatment strategy after medical therapy, mitral transcatheter edge-to-edge repair (M-TEER) has been reported in the emerging literature to alleviate the LVOT obstruction related to mitral regurgitation (MR) and systolic anterior motion (SAM).

AIMS: In this article, we aim to evaluate the efficacy and safety of M-TEER in managing symptomatic HCM.

METHODS

We conducted a systematic review according to Cochrane Handbook and the PRISMA statement. We comprehensively searched Embase, PubMed, and Scopus from inception to September 5, 2024, to identify case reports where symptomatic HCM were managed by M-TEER. The data extracted included patient demographics, procedural details, hemodynamics, and outcomes.

RESULTS

We identified 20 patients in the literature with symptomatic HCM who underwent M-TEER. The average age was 73.06 ± 13.81 years, predominantly male, 60%. All patients had evidence of intermittent LVOT obstruction, MR, and SAM. NYHA III-IV was the presenting symptom in 95% of the patients. M-TEER was performed in all patients, resulting in a significant improvement in the LVOT gradient from 68.9 ± 34.4 to 12.35 ± 9.6 mmHg, an average improvement in MR grade of 2.68, and a mean improvement in NYHA class of two. Nineteen patients had successful procedures, underscoring the potential of M-TEER in treating symptomatic HCM, while one patient succumbed to cardiogenic shock.

CONCLUSION

M-TEER appears to be viable and safe for managing symptomatic HCM due to LVOT obstruction secondary to MR and SAM in patients where SRT is deemed unsuitable. However, more evidence in a larger scale is required to demonstrate its long-term efficacy and outcomes.