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Publications

Journal Article Ahead of print

PubMed: 42660223 DOI: 10.1016/j.rec.2026.08.004

Early changes in pulmonary arterial systolic pressure after transcatheter edge-to-edge mitral valve repair and their association with outcomes.

Rev Esp Cardiol (Engl Ed)

Authors: Gaspard Suc, MyLien Nguyen, Caroline Chong-Nguyen, Mustafa Habib, Jorge Nuche, Manuel Giráldez, Fernando Sarnago-Cebada, Isaac Pascual, Iria Silva, Jean-Michel Paradis, Josep Rodés-Cabau, Grégory Ducrocq, Jules Mesnier, Bernard Iung, Fabien Praz, Marina Urena

Affiliations

  • Department of Cardiology, Hôpital Bichat-Claude Bernard, AP-HP, Université Paris Cité, Paris, France.
  • Department of Cardiology, Hôpital Bichat-Claude Bernard, AP-HP, Université Paris Cité, Paris, France.
  • Department of Cardiology, Biel/Bienne Hospital, Biel/Bienne, Switzerland; Department of Angiology, Bern University Hospital (Inselspital), Bern, Switzerland; Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.
  • Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
  • Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
  • Servicio de Cardiología, Hospital Universitario Central de Asturias (HUCA), Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain.
  • Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Québec City, Canada.
  • Department of Cardiology, Biel/Bienne Hospital, Biel/Bienne, Switzerland; Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.
  • Department of Cardiology, Hôpital Bichat-Claude Bernard, AP-HP, Université Paris Cité, Paris, France.

Abstract

INTRODUCTION AND OBJECTIVES

Transcatheter edge-to-edge repair (TEER) is a treatment for high-surgical-risk patients with severe mitral regurgitation. While pulmonary hypertension (PH) predicts poor outcomes after mitral surgery, its impact after TEER remains uncertain. The aim of this study was to assess early changes in systolic pulmonary arterial pressure (sPAP) after TEER and their association with outcomes.

METHODS

This multicenter, retrospective cohort study included 378 patients undergoing TEER between 2012 and 2023. sPAP was measured by transthoracic echocardiography before the procedure and on day 1. PH was defined as sPAP > 50 mmHg pre-TEER and > 40 mmHg post-TEER. Patients were classified into 4 groups: no PH (no PH before or after TEER), new PH (normal baseline sPAP with postprocedural PH), normalized PH (baseline PH with normalization after TEER), and persistent PH (PH before and after TEER). The primary endpoint was a composite of all-cause mortality, heart failure hospitalization, or mitral valve reintervention at 2 years.

RESULTS

Median age was 80 [interquartile range, 74-85] years, and 43% were women; 39% had baseline PH. Post-TEER, 24% developed new PH and 27% had persistent PH, resulting in residual PH in 51% of patients. Predictors of residual PH included age (aOR, 1.03/y), chronic lung disease (aOR, 2.20), baseline sPAP > 50 mmHg (aOR, 3.44), and higher postprocedural transmitral gradient (aOR, 1.18/ mmHg), while primary mitral regurgitation was protective (aOR, 0.48). Unlike baseline PH, residual PH was independently associated with the primary endpoint (aHR, 2.26).

CONCLUSIONS

Residual PH is common after TEER and is independently associated with adverse outcomes. Early postprocedural sPAP assessment may refine risk prognostication.

MeSH

Mitral Valve, Cardiovascular Diseases, Echocardiography, Mitral Valve Insufficiency