Elsevier

International Journal of Cardiology

Volume 338, 1 September 2021, Pages 72-78
International Journal of Cardiology

Transcatheter mitral valve repair may increase eligibility for heart transplant listing in patients with end-stage heart failure and severe secondary mitral regurgitation

https://doi.org/10.1016/j.ijcard.2021.06.031Get rights and content
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open access

Highlights

  • Mitral valve regurgitation often originates from end-stage heart failure

  • Heart transplantation remains the gold standard for HFrEF patients

  • Pulmonary hypertension is often a reason for ineligibility for transplantation

  • Organ shortage and long waiting times leave only a short window

  • Transcatheter mitral valve repair may increase eligibility for heart transplantation

Abstract

Background

Heart transplantation remains the gold standard for treatment of patients with end-stage heart failure and severely reduced ejection fraction (HFrEF). An increased pulmonary vascular resistance (PVR), which is often prevalent in HFrEF patients with secondary mitral regurgitation (SMR), limits the eligibility for transplantation. Therefore, we evaluated whether transcatheter mitral valve repair (TMVr) improves pulmonary circulatory hemodynamics and increases the eligibility for transplantation in end-stage HFrEF patients with severe SMR.

Methods

We retrospectively analysed the hemodynamics by right heart catheterization (RHC) as well as laboratory and clinical outcomes of end-stage HFrEF patients with SMR that underwent TMVr.

Results

Seventeen patients (age: 55 ± 10 yrs) underwent TMVr and repeat RHC at a mean follow-up of 5.7 ± 7.9 months. TMVr decreased PVR (3.5 ± 2.2 to 2.3 ± 1.2 wood units, p = 0.02) and systolic pulmonary artery pressure (55.4 ± 15 mmHg to 45.6 ± 9.8 mmHg, p = 0.02) from baseline to follow-up, respectively, while cardiac output was increased (3.7 ± 0.9 l/min to 4.6 ± 1.3 l/min, p = 0.02). In addition, transpulmonary gradient decreased significantly (12.0 ± 7.5 mmHg to 9.7 ± 5.3 mmHg, p = 0.04). The prevalence of New York Heart Association functional class ≥III at follow-up was reduced from 88% (15/17 patients) to 47% (8/17 patients, p = 0.01). All five patients with initially too high PVR (>3.5 WU) showed a significant decrease in PVR and three of them became potential candidates for heart transplantation after TMVr.

Conclusion

TMVr is associated with reduction in PVR which may increase eligibility for transplantation in some HFrEF patients with severe SMR.

Keywords

Heart transplantation
Transcatheter mitral valve repair
Pulmonary hypertension
Mitral regurgitation

Cited by (0)

1

All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

2

Shared senior authorship.