AUTHOR=Nita Nicoleta , Schneider Leonhard , Dahme Tilman , Markovic Sinisa , Keßler Mirjam , Rottbauer Wolfang , Tadic Marijana 

TITLE=Trends in Transcatheter Edge-to-Edge Mitral Valve Repair Over a Decade: Data From the MiTra ULM Registry

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.850356

DOI=10.3389/fcvm.2022.850356

ISSN=2297-055X

ABSTRACT=Objective: The study sought to determine the potential change in trends in baseline characteristics of patients with symptomatic severe mitral regurgitation who underwent transcatheter edge-to-edge mitral valve repair (M-TEER) over the last decade in a high-volume center. 
Methodology: Investigation included 942 symptomatic patients with moderate-to-severe and severe mitral regurgitation who underwent TEER at our institution between January 2010 and March 2021. Patients were divided into quintiles and compared separately.
Results: Patients treated in the last quintile had significant lower surgical risk (Euro Score 7.2 ± 6.8 % in last quintile vs. 10.9 ±9.4 % in first quintile, p <0.001), better NYHA status (NYHA IV 14% in last quintile vs. 40% in first quintile, p<0.001), lower NT-pro-BNP and smaller left ventricle diameter than patients who were treated in the first quintile. There was no difference in age between quintiles. However, invasive hemodynamic assessment did not show significant changes over the last decade (sPAP 51.35 ± 16.2 mmHg in first quintile vs. 51.02 ± 14.5 mmHg in last quintile, p=0.90, pulmonary capillary wedge V wave 30.7±14.8 mmHg in first quintile vs. 27.4±10.3 mmHg in last quintile, p=0.40). There is a significant trend of increased proportion of patients with degenerative MR gradually over last 10 years (p<0.001). The experience in M-TEER procedure brought significant reduction in fluoroscopy time and hospitalization duration, but the short-term outcome remained unchanged over the last decade. Medical therapy significantly changed over the last decade in terms of higher use of ARBs and lower use of ACEIs, as well as the introduction of ARNI. 
Conclusion: Patients receiving M-TEER procedure nowadays have lower surgical risk and are treated before they develop a significant LV remodeling than before. Increasing procedure expertise led over the last decade to rising number of patients with complex degenerative pathology being treated.