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Open Access 16-11-2021 | Heart Failure | Original Paper

Impact of asymmetric tethering on outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation

Authors: Lukas Stolz, Mathias Orban, Daniel Braun, Philipp Doldi, Martin Orban, Konstantin Stark, Michael Mehr, Julius Steffen, Kornelia Löw, Christian Hagl, Steffen Massberg, Michael Näbauer, Jörg Hausleiter

Published in: Clinical Research in Cardiology | Issue 8/2022

Abstract

Background

The impact of postero-anterior and medio-lateral mitral valve (MV) tethering patterns on outcomes in patients undergoing transcatheter edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR) is unknown.

Methods

The ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in MV segment 2 was defined as postero-anterior tethering asymmetry. Medio-lateral tethering asymmetry was assessed as the ratio of the medial (segment 3) to lateral (segment 1) MV tenting area. We used receiver-operating characteristics and a Cox regression model to identify cut-off values of asymmetric anteroposterior and medio-lateral tethering for prediction of 2 year all-cause mortality after TMVR.

Results

Among 178 SMR patients, postero-anterior tethering was asymmetric in 67 patients (37.9%, PLA/ALA ratio > 1.54). Asymmetric medio-lateral tethering (tenting area ratio > 1.49) was observed in 49 patients (27.5%). M-TEER reduced MR to ≤ 2 + in 92.1% of patients; MR reduction was less effective in the presence of asymmetric postero-anterior tethering (p = 0.02). A multivariable Cox regression model identified both types of asymmetric MV tethering to be associated with increased all-cause 2-year mortality (postero-anterior tethering asymmetry: HR = 2.77, CI 1.43–5.38; medio-lateral tethering asymmetry: HR = 2.90, CI 1.54–5.45; p < 0.01).

Conclusions

Asymmetric postero-anterior and medio-lateral MV tethering patterns are associated with increased 2-year mortality in patients undergoing M-TEER for SMR. A detailed echocardiographic analysis of MV anatomy may help to identify patients who profit most from M-TEER.

Graphical abstract

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Title: Impact of asymmetric tethering on outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation
Authors: Lukas Stolz
Mathias Orban
Daniel Braun
Philipp Doldi
Martin Orban
Konstantin Stark
Michael Mehr
Julius Steffen
Kornelia Löw
Christian Hagl
Steffen Massberg
Michael Näbauer
Jörg Hausleiter
Publication date: 16-11-2021
Publisher: Springer Berlin Heidelberg
Keyword: Heart Failure
Published in: Clinical Research in Cardiology / Issue 8/2022
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-021-01961-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of asymmetric tethering on outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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