Outcomes of patients with mitral regurgitation and concomitant aortic and tricuspid valve disease after transcatheter edge-to-edge mitral valve repair

Patients with severe mitral valve regurgitation (MVR) and coincidental aortic or tricuspid valve disease represent a management challenge. Traditionally, if an interdisciplinary heart team decides to perform open-heart surgery to replace the mitral valve, aortic stenosis or regurgitation is usually corrected simultaneously. However, patients at high surgical or prohibitive risks are typically referred to a less invasive alternative such as transcatheter edge-to-edge mitral valve repair (TEER) for severe mitral valve regurgitation. We decided to observe the outcomes of the patients who underwent TEER for severe mitral valve regurgitation associated with aortic or tricuspid valve disease. In this retrospective cohort study, 170 patients participated that underwent TEER. Patients only with severe MVR 73/170 (42.9%) were compared to patients who had associated either moderate to severe aortic stenosis or regurgitation or tricuspid insufficiency 97/170 (57.1%). The patients had similar basic characteristics in terms of gender, prior diseases such as stroke, peripheral arterial disease, diabetes, heart failure, chronic lung disease, KCCQ12 score, MR severity, and ejection fraction. We assessed the impact of coincidental aortic or tricuspid valve disease on post-TEER outcomes such as MR reduction, total-in-hospital stay, and mortality. Post-TEER, no difference was found in reducing the severity of MR (p=0.91.), total-in-hospital stay (p=0.77), and survival between patients with only MVR and patients with MVR associated with either aortic stenosis or regurgitation or tricuspid insufficiency. Both groups exhibited a reduction in the severity of MR, average total in-hospital stay of 6.33∼ 6.73 (mean 6.53), and survival of 100% compared to another group with good outcomes. There was no difference in feasibility and short-term outcomes of TEER in patients only with MVR compared to patients with MVR and associated aortic or tricuspid valve disease. In the era of minimally invasive procedures such as TEER, when performed in patients with concomitant and very often complicated valve pathology, we need large-scale trials to follow up on these patients' short- and long-term outcomes.