Transcatheter mitral valve repair may increase eligibility for heart transplant listing in patients with end-stage heart failure and severe secondary mitral regurgitation

Abstract

Background: Heart transplantation remains the gold standard for treatment of patients with end-stage heart failure and severely reduced ejection fraction (HFrEF). An increased pulmonary vascular resistance (PVR), which is often prevalent in HFrEF patients with secondary mitral regurgitation (SMR), limits the eligibility for transplantation. Therefore, we evaluated whether transcatheter mitral valve repair (TMVr) improves pulmonary circulatory hemodynamics and increases the eligibility for transplantation in end-stage HFrEF patients with severe SMR.

Methods: We retrospectively analysed the hemodynamics by right heart catheterization (RHC) as well as laboratory and clinical outcomes of end-stage HFrEF patients with SMR that underwent TMVr.

Results: Seventeen patients (age: 55 ± 10 yrs) underwent TMVr and repeat RHC at a mean follow-up of 5.7 ± 7.9 months. TMVr decreased PVR (3.5 ± 2.2 to 2.3 ± 1.2 wood units, p = 0.02) and systolic pulmonary artery pressure (55.4 ± 15 mmHg to 45.6 ± 9.8 mmHg, p = 0.02) from baseline to follow-up, respectively, while cardiac output was increased (3.7 ± 0.9 l/min to 4.6 ± 1.3 l/min, p = 0.02). In addition, transpulmonary gradient decreased significantly (12.0 ± 7.5 mmHg to 9.7 ± 5.3 mmHg, p = 0.04). The prevalence of New York Heart Association functional class ≥III at follow-up was reduced from 88% (15/17 patients) to 47% (8/17 patients, p = 0.01). All five patients with initially too high PVR (>3.5 WU) showed a significant decrease in PVR and three of them became potential candidates for heart transplantation after TMVr.

Conclusion: TMVr is associated with reduction in PVR which may increase eligibility for transplantation in some HFrEF patients with severe SMR.

Keywords: Heart transplantation; Mitral regurgitation; Pulmonary hypertension; Transcatheter mitral valve repair.