Findings from Transoesophageal Echocardiographic Follow-Up after Mitral Transcatheter Edge-to-edge Repair

Joanna Bartkowiak,Mohammad Kassar, Salomon J. Bruelisaucr, Laura Bubulyte,Daryoush Samim,Andrea Ruberti,Raouf Madhkour,Lutz Buellesfeld,Stephan Windecker,Thomas Pilgrim,Nicolas Brugger,Fabien Praz

EUROINTERVENTION（2024）

Univ Bern | GFO Hosp Bonn

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Abstract

BACKGROUND: Transoesophageal echocardiography (TOE) provides accurate evaluation of mitral valve (MV) function following mitral transcatheter edge-to-edge repair (M-TEER) and may better detect complications in case of suboptimal result. AIMS: We aimed to evaluate midterm anatomical changes and structural complications after M-TEER using TOE and investigate their association with clinical outcomes at 2 years. METHODS: A follow-up TOE at 6 months was systematically recommended to all patients included in our institutional prospective M-TEER registry until December 2021. We assessed changes in the incidence of mitral regurgitation (MR), MV stenosis (>= 5 mmHg), and partial or complete single leaflet device attachment (SLDA) between the index procedure and follow-up and evaluated MV area and annular dimensions in a subset of patients with available three-dimensional (3D) datasets. The clinical endpoint was a composite of mortality and heart failure (HF) rehospitalisation at 2 years. RESULTS: Among the 373 patients included in the registry between February 2012 and December 2021, 128 patients (34%) underwent elective TOE at 6 months. Using TOE, severe MR was observed in 13.3% (n=17) of the patients. The number of patients with an elevated MV gradient increased from 17 (13.3%) after the procedure to 23 (18%) at 6 months, and a new partial or complete SLDA was detected in 7.8% (n=10). Based on 3D TOE measurements, significant increases in MV area, annular area, annular perimeter, and intercommissural (but not anteroposterior) diameter were observed compared to intraprocedural images. A mean MV gradient >= 5 mmHg (hazard ratio [HR] 2.30, 95% confidence interval [CI]: 1.10-4.81; p=0.023) and the presence of severe MR at 6 months (HR 3.26, 95% CI: 1.18-8.99; p=0.023) were associated with the primary endpoint, which was met in 34 (26.6%) patients at 2 years. CONCLUSIONS: TOE follow-up allowed the detection of complications that would not be diagnosed using transthoracic echocardiography only and should therefore be used liberally in the patients presenting with a suboptimal result. A mean MV gradient >= 5 mmHg and severe MR, diagnosed at the 6-month TOE follow-up, were associated with adverse clinical outcomes.

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Key words

degenerative valve,elderly (>75 years),imaging modalities,mitral regurgitation,mitral valve disease,transoesophageal echocardiogram

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【要点】：本研究通过经食管超声心动图（TOE）评估了经导管二尖瓣边缘对边缘修复（M-TEER）后中期的解剖变化和结构并发症，并探究了这些变化与2年临床结局的关联。

【方法】：对纳入机构前瞻性M-TEER注册数据库的所有患者在术后6个月系统性地推荐进行TOE检查，评估二尖瓣反流（MR）、二尖瓣狭窄（>= 5 mmHg）和单叶瓣装置部分或完全附着（SLDA）的发生率变化，并在有三维（3D）数据集的患者中评估二尖瓣面积和环径。

【实验】：在373名患者中，128名（34%）在6个月时进行了选择性TOE检查。TOE显示，13.3%（n=17）的患者存在严重MR。术后6个月，二尖瓣梯度升高的患者数量从13.3%（n=17）增加到18%（n=23），新发现的SLDA为7.8%（n=10）。基于3D TOE测量，与术中图像相比，二尖瓣面积、环面积、环周长和交界直径（而非前后径）显著增加。平均二尖瓣梯度>= 5 mmHg和6个月时严重MR与不良临床结局相关。