Pulmonary Venous Flow Patterns Associated with Long-term Mitral Transcatheter Edge-to-edge Outcomes

Background Transcatheter edge-to-edge repair (TEER) is a prominent therapeutic option for mitral regurgitation (MR) patients. However, it lacks objective parameters to assess procedural efficacy. This study aims to investigate the pulmonary venous (PV) flow as a surrogate for valvular hemodynamics and its associations to clinical outcomes. Methods Consecutive MR patients who underwent TEER in our center from 01/2020-10/2021 were retrospectively investigated. PV flow parameters were measured before and after TEER, including velocity (cm/s), velocity time integral (VTI) (cm) and systolic/diastolic ratios. Primary outcomes were 1, 6, and 12 months heart failure hospitalizations (HFH) and 1 year all-cause mortality. Results The cohort consisted of 80 patients. The mean age was 74.76±10.13 years, 26 with primary and 54 with secondary MR. Systolic wave parameters improved significantly after TEER: mean peak-velocity increased from 9.94±31.95 to 35.74±15.03 cm/s, and VTI from 3.62±5.99 to 8.33±4.72 cm. Furthermore, systolic to diastolic VTI and peak-velocities ratios showed significant improvement 0.39±0.63 to 0.81±0.47 and 0.23±0.66 to 0.91±0.43 respectively.Using multivariable analysis, higher post-procedural SVTI was associated with less HFH: 1-month (OR=0.72,CI[0.52,0.98]), 6-months (OR=0.8,CI[0.66,0.97]), 1-year (OR=0.85,CI[0.73,0.99]), as well as reduced 1-year mortality (OR=0.64 95% CI[0.45,0.91]). Furthermore, compared to patients with SVTI≥3, patients with SVTI<3 had higher risk for HFH at: 1-month (OR=16.59,CI[1.48,186.02]), 6-months (OR=12.2,CI[1.69,88.07]), and 1-year (OR=8.61,CI[1.27,58.27]), as well as elevated 1-year mortality (OR=8.07, 95% CI[1.04,62.28]). Conclusions PV flow was significantly improved following TEER, and several hemodynamic parameters were associated HFH and mortality. These results may offer a basis for establishing future procedural goals to ensure better clinical outcomes.