NEW research has revealed that residual mitral regurgitation (MR) assessed by 3D-Vena Contracta Area (VCA) during transcatheter edge-to-edge repair (TEER) significantly predicts one-year mortality.
This study utilised data from the MITRA-PRO registry, which evaluated 823 patients who underwent mitral TEER with residual MR quantified by 3D-VCA. The findings demonstrated that residual MR, a critical factor in determining outcomes, can be reliably assessed intraprocedurally using 3D-VCA. Patients were categorised into three groups based on their residual 3D-VCA: trace MR (<0.1 cm²), mild MR (≥0.1 to <0.3 cm²), and relevant MR (≥0.3 cm²). The study investigated associations between 3D-VCA values and one-year mortality, alongside secondary outcomes like New York Heart Association (NYHA) classification and major adverse events.
Patients with non-relevant residual MR had significantly better survival outcomes, with one-year mortality rates of 10.5% for trace MR, 16.0% for mild MR, and 24.8% for relevant MR (p=0.003). A 3D-VCA of 0.07 cm² emerged as a critical threshold, as patients with post-TEER 3D-VCA ≥0.07 cm² exhibited higher one-year mortality (16.5% vs. 7.8% for <0.07 cm², p=0.005). These findings underscore that achieving a lower 3D-VCA intraprocedurally may improve survival outcomes.
The results suggest that integrating 3D-VCA measurements into clinical practice during mitral TEER provides an effective strategy to guide procedural decisions. Achieving minimal residual MR by targeting a 3D-VCA below 0.07 cm² may optimise patient survival. Future research should further explore standardised protocols and the impact of real-time 3D-VCA guidance on procedural success. Clinicians are encouraged to consider 3D-VCA as a critical echocardiographic parameter to enhance outcomes in mitral TEER procedures.
Katrina Thornber, EMJ
Reference
Rottländer D et al. Intraprocedural 3D-vena contracta area predicts survival after transcatheter edge-to-edge repair: results from MITRA-PRO registry. Clin Res Cardiol. 2024;DOI:10.1007/s00392-024-02580-6.
