Abstract 4361136: Mitral Transcatheter Edge-to-Edge Repair in Patients with Severe Pulmonary Hypertension

Abstract

Background: There is little evidence regarding mitral transcatheter edge-to-edge repair (TEER) in the setting of severe pulmonary hypertension (PH), defined by an estimated pulmonary arterial systolic pressure (PASP) >70 mmHg on echocardiography. Objectives: To explore the prevalence of, and correlates and postprocedural outcomes associated with, severe PH in patients undergoing mitral TEER. Methods: We retrospectively evaluated a single-center registry of isolated, first-time interventions as a function of severe PH presence at baseline. Outcomes included all-cause mortality, heart failure (HF) hospitalizations, and the persistence of significant mitral regurgitation (MR) and functional impairment during the first postprocedural year. Results: A total of 1,182 individuals qualified for analysis. Of them, 100 (8.5%) had severe PH, demonstrating a median PASP of 78 (IQR, 75-85) mmHg. Compared to subjects free of severe PH, those with it exhibited a higher interventional risk, greater comorbidities, and more severe MR and cardiac dysfunction, and were more likely to undergo an urgent procedure. General interventional features were unaffected by severe PH status, leading in both study groups to a high (>97%) technical success rate and, ultimately, significant improvement in PASP, MR grade and functional capacity. Severe PH was associated with worse residual MR in the total cohort – but not within a 187-patient, propensity score matched sub-cohort. In either, it did not impact the rate, cumulative incidence, and risk of mortality and/or HF hospitalizations. Conclusions: Mitral TEER in patients with severe PH should, in the hands of experienced interventionalists, prove feasible, safe, and efficacious.