Journal Article Ahead of print
PubMed: 41860934 DOI: 10.1093/ejcts/ezag107
Evolution of right ventricular function and pulmonary artery coupling after transapical transcatheter mitral valve replacement.
Eur J Cardiothorac Surg
Authors: Amedeo Anselmi, Michaela Hell, Stephan Baldus, Anna Sonia Petronio, Tanja Rudolph, Thomas Modine, Martin Andreas, Joerg Hausleiter, Luis Nombela-Franco, Augustin Coisne, Fabien Praz, Alison Duncan, Hendrik Ruge, Lenard Conradi, Georg Nickenig, Miguel Pinon, Nicolas Dumonteil, Andreas Zierer, Marianna Adamo, Vanessa Monivas, Sebastian Barth, Francesco Maisano, Andrea Fumero, Christophe Dubois, Juan Munguira, Francesco Musumeci, Felix Kreidel, Gaby Aphram, Thomas Walther, Philip Lurz, Riccardo Gherli, Mirjam Wild, Pierre Flores, Guillaume Leurent, Ralph Stephan VON Bardeleben, Erwan Donal
Affiliations
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, F-35000 Rennes.
- Heart Valve Center Mainz/Structural Heart and valvular Interventions, ACHD, Cardiology, CV Imaging.
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany.
- Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy.
- Heart and Diabetes Center NRW, Department of General and Interventional Cardiology/Angiology, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
- CHU Bordeaux, Hopital Cardiologique Haut Leveque, Pessac, France.
- Medical University of Vienna, Vienna, Austria and Medical University Graz, Graz, Austria.
- Medizinische Klinik I, LMU University Hospital, Munich, Germany.
- Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain.
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000, Lille, France.
- Cardiovascular Research Foundation, New York City, NY, USA.
- Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland.
- Heart Division, Royal Brompton Hospital, London, United Kingdom.
- Technical University of Munich, TUM School of Medicine and Health, Department of Cardiovascular Surgery, TUM University Hospital German Heart Center.
- University Heart and Vascular Center Hamburg, Hamburg, Germany.
- Heart Center University Hospital, Bonn, Germany.
- Cardiac Surgery. Hospital Álvaro Cunqueiro. Vigo, Spain.
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France.
- Department for Cardiac, Vascular, and Thoracic Surgery, Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria.
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
- Cardiology Dept, Puerta de Hierro Hospital, Madrid, Spain.
- Klinik für Kardiologie, Campus Bad Neustadt, Germany.
- Valve Center, IRCCS Ospedale San Raaffaele and University Vita Salute, Milan, Italy.
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, Rozzano, 20089, Italy.
- Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium and Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
- Department of Cardiac Surgery. Hospital, Clinico Universitario de Valladolid. Valladolid, Spain.
- Cardiac Surgery and Heart Transplantation Unit, San Camillo Hospital, Rome, Italy.
- Department of Internal Medicine III, Cardiology and Critical Care, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
- Department of cardiology, cliniques universitaires Saint-Luc, Bruxelles.
- Department of Cardiac, Thoracic and vascular surgery, University Hospital Frankfurt, Frankfurt, Germany.
- Department of Cardiology, Heart Center Leipzig, Leipzig, Germany.
- Department of Cardiac Surgery, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology and Angiology, University of Freiburg, Germany.
Abstract
OBJECTIVES
Transcatheter mitral valve replacement (TMVR) is an emerging therapy for patients with severe mitral regurgitation (MR) who are not suitable for surgery or edge-to-edge repair. The impact of TMVR on right ventricular (RV) function, and RV-pulmonary artery (PA) coupling remains poorly understood. We aimed to investigate the prognostic significance of right heart function and RV-PA coupling in TMVR recipients.
METHODS
This study evaluated patients from the multicentre TENDER registry entailing transapical TMVR with the Tendyne© valve. We assessed RV systolic function, tricuspid regurgitation (TR), systolic pulmonary artery pressure (sPAP), and the TAPSE/sPAP ratio as a marker of RV-PA coupling before and one year after TMVR.
RESULTS
Among 195 patients, 57.4% had impaired RV-PA coupling (TAPSE/sPAP < 0.4) at baseline. One-year after TMVR, sPAP and TR severity significantly improved, while TAPSE slightly declined. The TAPSE/sPAP ratio increased modestly. Patients with preserved baseline RV-PA coupling experienced numerically lower rates of mortality and heart failure hospitalization at one year, although the differences did not reach the statistical significance. Reversal of pulmonary hypertension was associated with lower mortality or rehospitalization risk.
CONCLUSIONS
RV dysfunction and impaired RV-PA coupling are frequent among TMVR candidates. They may inform risk stratification and carry prognostic significance. TMVR is associated with haemodynamic improvements that could benefit RV-PA coupling. Patients with secondary MR, with baseline association of impaired coupling and severe TR, or failed reversal of pulmonary hypertension, may require closer clinical follow-up. Further studies are warranted to validate these findings.
MeSH
Hypertension, Mortality, Thoracic Surgery, Hypertension, Pulmonary, Mitral Valve, Hospitalization, Heart, Pulmonary Artery, Arteries, Ventricular Function, Ventricular Function, Right, Transcatheter Mitral Valve Replacement