Outcomes of Transcatheter Edge-to-Edge Repair in Potentially Favorable Candidates for Left Ventricular Assist Device: Evidence From the OCEAN-Mitral Registry.

BACKGROUND

Transcatheter edge-to-edge repair of the mitral valve (M-TEER) has shown promising outcomes in patients with advanced heart failure and significant mitral regurgitation. Similarly, outcomes after left ventricular assist device (LVAD) implantation have improved in advanced heart failure with/without mitral regurgitation. However, the indication of M-TEER in favorable candidates for LVAD therapy remains unclear.

METHODS

Potentially favorable LVAD candidates were defined as patients with advanced heart failure and secondary mitral regurgitation who underwent M-TEER and were considered theoretically suitable for LVAD therapy based on data from the optimized catheter valvular intervention (OCEAN)-Mitral registry. Among this cohort, Cox proportional hazards regression analysis was performed to identify factors associated with cardiovascular death following M-TEER.

RESULTS

A total of 3764 patients who underwent M-TEER were included. Of them, 129 were identified as potentially favorable LVAD candidates (mean age: 67 years; 67% men). Despite advanced heart failure, procedural success was 96%. The 1-year rate of cardiovascular death was 10.1%, increasing to 38.9% at 3 years. Baseline left ventricular end-diastolic diameter was independently associated with cardiovascular death (hazard ratio: 1.07 per 1-mm increase; 95% CI: 1.02-1.12; P=0.01). In patients with markedly enlarged left ventricles, symptom improvement was limited, and reverse remodeling was not achieved.

CONCLUSIONS

M-TEER can be safely performed even in potentially favorable LVAD candidates. However, long-term efficacy appears limited, particularly in those with advanced LV remodeling. Further studies are warranted to establish an optimal strategy, including the role of LVAD therapy versus M-TEER, for this high-risk population.

REGISTRATION: URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000027188.