BACKGROUND Mitral valve transcatheter edge-to-edge repair (M-TEER) reduces secondary mitral regurgitation (MR) in heart failure and impacts survival in selected patients as demonstrated in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. However, long-term outcome data after M-TEER under real-world conditions are lacking. OBJECTIVES This study sought to assess long-term efficacy and survival after M-TEER in a large real-world registry. METHODS We analyzed patients with significant secondary MR undergoing M-TEER from the EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry. Long-term MR reduction, functional outcomes, survival rate, and predictors for all-cause mortality were assessed. RESULTS In this study, 1,628 patients undergoing M-TEER (mean age 73.8 years, mean EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 6.9%, 86.6% NYHA functional class ≥III) with available long-term data were included. Five-year survival was 35.0%. Long-term MR reduction (MR grade ≤2+: baseline 4.1%, discharge 92.2%, 5-year follow-up 85.5%; P < 0.001) and functional improvement (NYHA ≤II: baseline 13.4%, 5-year follow-up 60.1%; P < 0.001) was observed. The degree of residual MR was associated with 5-year survival (residual MR grade ≤1+: 38.6%; 2+: 30.5%; ≥3+: 22.6%; P < 0.001). Independent predictors for 5-year all-cause mortality post-M-TEER included age, renal function, residual MR, NYHA functional class, left ventricular ejection-fraction, and COAPT trial eligibility (P < 0.01 for all). CONCLUSIONS This extensive multicenter registry underscores the long-term efficacy of M-TEER in real-world clinical practice and identifies predictors for long-term survival. These findings contribute valuable insights for optimizing patient selection in routine clinical interventions.

中文翻译：

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继发性二尖瓣反流边缘到边缘修复后的长期结果：来自 EuroSMR 登记处的 5 年结果。


背景 二尖瓣经导管边对边修复 （M-TEER） 可减少心力衰竭的继发性二尖瓣反流 （MR） 并影响特定患者的生存率，如 COAPT （MitraClip 经皮治疗功能性二尖瓣反流患者的心血管结果评估）试验所示。然而，在真实世界条件下缺乏 M-TEER 后的长期结果数据。目的 本研究试图在大型真实世界登记库中评估 M-TEER 后的长期疗效和生存率。方法 我们分析了来自 EuroSMR （欧洲继发性二尖瓣反流经导管修复登记处） 登记处接受 M-TEER 的显着继发性 MR 患者。评估长期 MR 减少、功能结局、生存率和全因死亡率的预测因子。结果 在本研究中，纳入了 1,628 例接受 M-TEER 的患者 （平均年龄 73.8 岁，平均 EuroSCORE II [欧洲心脏手术风险评估系统 II] 6.9%，86.6% NYHA 功能分级 ≥III） 有可用的长期数据。五年生存率为 35.0%。长期 MR 降低 （MR 分级 ≤2+：基线 4.1%，出院 92.2%，5 年随访 85.5%;P < 0.001） 和功能改善 （NYHA ≤II： 基线 13.4%，5 年随访 60.1%;P < 0.001）。残余 MR 的程度与 5 年生存率相关 （残余 MR 分级 ≤1+： 38.6%;2+： 30.5%;≥3+： 22.6%;P < 0.001）。M-TEER 后 5 年全因死亡率的独立预测因素包括年龄、肾功能、残余 MR、NYHA 功能分级、左心室射血分数和 COAPT 试验合格性 （P < 0.01）。 结论 这个广泛的多中心登记强调了 M-TEER 在实际临床实践中的长期疗效，并确定了长期生存的预测因子。这些发现为优化常规临床干预中的患者选择提供了有价值的见解。