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Valvular & structural heart diseaseCohort study

Implications of Mitral Annular Disjunction in Patients Undergoing Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation

JACC Cardiovasc IntervPublished

  • Retrospective cohort study
  • consecutive patients
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Authors' conclusion

In our experience, TEER for degenerative MR accompanied by MAD was feasible and safe; however, its postprocedural course was somewhat less favorable. MAD shortening following TEER was observed in most patients and proved prognostically beneficial.

Study context

Population
Patients undergoing isolated, first-ever mitral transcatheter edge-to-edge repair (TEER) for degenerative mitral regurgitation (MR)
Participants
271 consecutive patients
Exposure
Mitral annular disjunction (MAD) vs no MAD in patients undergoing TEER
  • MADn = 62
Outcome
Composite of:
  • All-cause mortality
  • HF hospitalizations
  • Mitral reinterventions
Follow-up
First postprocedural year

Main finding

All-cause mortality

Hazard ratio

2.64

95% CI 1.82–5.52

P = 0.014

MAD vs No MAD
HR 2.64 (95% CI 1.82–5.52); P = 0.014

As reported in the abstract

Observational data: associations, not effects.

Further findings

OutcomeOR (95% CI)P value
Functional class ≤II, per increase in MAD length0.65 (0.47–0.88)P = 0.006
MAD regression at 1 month (MAD patients with retrievable data)
50% · IQR 22%–100%
  • MAD regression at 1 month (MAD patients with retrievable data): n = 47
  • MAD regression at 1 month (MAD patients with retrievable data): vs baseline P < 0.001

Procedural results

MAD procedures longer, more devices per case; technical success rate and residual MR comparable

Primary outcome by MAD shortening

Greater MAD shortening conferred attenuated risk for the primary outcome

Original publication

Implications of Mitral Annular Disjunction in Patients Undergoing Transcatheter Edge-to-Edge Repair for Degenerative Mitral Regurgitation. JACC Cardiovasc Interv. Published 11 December 2023. doi:10.1016/j.jcin.2023.10.012
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Summarised from the published abstract; every number is checked against it