Intraprocedural Residual Mitral Regurgitation and Survival After Transcatheter Edge-to-Edge Repair Prospective German Multicenter Registry (MITRA-PRO)

BACKGROUND Residual mitral regurgitation (MR) is thought to be an important predictor of long-term survival following transcatheter edge-to-edge repair (TEER). Intraprocedural MR assessment using transesophageal echocardiography could be limited by image quality, hemodynamics, and patient sedation. The MitraScore is a validated multimodal approach for intraprocedural MR assessment during TEER.OBJECTIVES This study aimed to assess the impact of residual MR using the MitraScore on 1-year mortality. METHODS Patients undergoing mitral TEER were eligible for inclusion in the prospective, multicenter MITRA-PRO registry (A Prospective Registry Study on 1-Year Mortality and the Prognostic Significance of MitraScore After MitraClip Implantation in Patients With Mitral Regurgitation). Patients with a MitraScore <= 3 were defined as patients with mild residual MR after mitral TEER, whereas a MitraScore >= 4 was considered as relevant residual MR. Mortality, rehospitalization, and major adverse events were assessed 1 year after TEER.RESULTS A MitraScore <= 3 was found in 1,059 patients (71.0%), whereas 432 patients revealed a MitraScore >= 4 (29.0%). One-year mortality was significantly lower in patients with nonrelevant residual MR (MitraScore <= 3 14.6% vs MitraScore >= 4 22.1%). An almost linear relationship between intraprocedural MitraScore after TEER and mortality was observed. The combined clinical endpoint of mortality and rehospitalization within the 1-year follow-up was also significantly lower in the MitraScore <= 3 group (31.5%) than in the MitraScore >= 4 group (40.8%). A subgroup analysis confirmed the predictive value of the MitraScore in patients with primary, secondary, or mixed MR etiologies.CONCLUSIONS Residual MR assessed by intraprocedural MitraScore after TEER predicts 1-year mortality and rehospitalization. Therefore, the multimodal MitraScore improves MR assessment during mitral TEER and might improve patient survival.(A Prospective Registry Study on 1-Year Mortality and the Prognostic Significance of MitraScore After MitraClip Implantation in Patients With Mitral Regurgitation [MITRA-PRO]; DRKS00012288) (J Am Coll Cardiol Intv 2023;16:574-585) (c) 2023 by the American College of Cardiology Foundation.