Transcatheter treatment of severe mitral regurgitation in high surgical risk patients: analysis of clinical and echocardiographic data from a referral center

Résumé fourni par la source

Abstract Introduction Mitral regurgitation (MR) is the most common valvular heart disease, affecting 2-3% of the population, with a prevalence of around 10% in individuals over 75 years old. It is a frequent cause of decompensation in patients with heart failure (HF), associated with unfavorable clinical outcomes, including increased morbidity and mortality. Transcatheter mitral valve repair using an edge-to-edge mitral valve leaflet repair technique has become a therapeutic option for patients with severe MR who are considered high surgical risk. Transesophageal echocardiography (TEE) is crucial for determining eligibility, guiding the procedure, monitoring potential complications, and assessing the final result. Objectives To analyze data related to etiology (primary, secondary, and mixed), number of clips used, average age, severity of MR, and the final procedure outcome. Methods We conducted a descriptive analysis of a series of 43 cases of high surgical risk severe mitral regurgitation from 2019 to 2024 at a referral hospital in São Paulo, indicated for transcatheter treatment by a "heart team". We described the prevalence of etiologies, average age, pre-procedure MR severity, and final echocardiographic outcome. Continuous variables were described as mean and standard deviation. Results We analyzed 43 cases of transcatheter mitral valve implantation from 2019 to 2024. One patient died on the first day post-procedure. Of the total cases, 42% had primary MR, 38% secondary MR, and 20% mixed etiology. The average age of the patients was 79.8 years and the number of implanted clips was 1.62 ± 0.72, considering all the cases. A decrease in the average number of clips implanted is observed When analyzed separately by year: in 2019, na average of 2.3±1, and in 2023/2024, 1.8±0.7. All procedures were performed in a catheterization or hybrid room, guided by TEE with the addition of three-dimensional technology. Using a grading scale for MR from mild (1+) to severe (4+), evaluated by TEE, the average after clip implantation was 1.27 ± 0.59. Regarding the mean gradient, the average post-procedure was 3 ± 1.2 mmHg. Conclusion The use of the transcatheter mitral valve implantation, following anatomical criteria for mitral valve selection, proved to be an effective and safe therapeutic option for reducing MR in high-risk patients. TEE is an essential tool in patient eligibility, guiding the procedure, evaluating the final result, and identifying potential complications.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.