Preprocedural New York Heart Association Class IV Independently Predicts Mortality After Effective Edge-To-Edge Repair for Primary Mitral Regurgitation
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background In patients with primary mitral regurgitation (MR) (PMR), advanced symptoms classified as New York Heart Association (NYHA) class IV are typically driven by valve deterioration. Transcatheter edge-to-edge repair (mitral valve transcatheter edge-to-edge repair [M-TEER]) reliably achieves effective reduction of mitral regurgitation in high-risk patients. However, whether or not preprocedural NYHA class IV continues to predict outcomes after successful MR reduction remains unclear. Methods The Outcomes of Patients tReated wIth Mitral Transcatheter Edge-to-edge Repair for Primary Mitral Regurgitation Registry includes PMR patients undergoing M-TEER at 27 international sites between 2009 and 2023. Clinical outcomes were compared between patients in NYHA class IV and those in NYHA class II/III. Results A total of 2528 patients were included (median age 82 years [interquartile range (IQR) 76–85], 45.9% female), and 19.7% presented in NYHA class IV. Baseline left ventricular ejection fraction and right ventricular function did not differ significantly between groups. Procedural success (residual MR ≤ 1+: 66.7% vs. 64.6%, p = 0.55) and 2-year rehospitalization rates (17.9% vs. 20.4%, log-rank p = 0.78) were comparable. In contrast, 2-year all-cause mortality was higher in NYHA class IV patients (31.8% vs. 21.1%, log-rank p < 0.0001). Multivariable Cox regression confirmed preprocedural NYHA class IV as an independent predictor of mortality (hazard ratio [HR] 1.75; 95% CI 1.32–2.31; p < 0.001). Conclusions In PMR, preprocedural NYHA class IV remains an independent predictor of all-cause mortality after effective MR reduction with M-TEER, despite comparable postprocedural results.
Source: Structural Heart
Authors: Benedikt Koell, Lydia X. Plewe, Sebastian Ludwig, Jessica Weimann, Dhairya Patel, Lukas Stolz, Tetsu Tanaka, Teresa Trenkwalder, Felix Rudolph, Daryoush Samim, Philipp von Stein, Cristina Giannini, Julien Dreyfus, Andrea Scotti, Jean-Michel Paradis, Marianna Adamo, Nicole Karam, Yohann Bohbot, Anne Bernard, Bruno Melica, Yusuke Kobari, Yoan Lavie-Badie, Mirjam Kessler, Omar Chehab, Simon Redwood, Edith Lubos, Ole de Backer, Marco Metra, Azeem Latib, Chiara Primerano, Christos Iliadis, Fabien Praz, Muhammed Gerçek, Erion Xhepa, Marcel Weber, Raj Makkar, Juan Granada, Thomas Modine, Erwan Donal, Jörg Hausleiter, Augustin Coisne, Daniel Kalbacher, Anna Sonia Petronio, Marcel Weber, Tobias Rheude, Volker Rudolph, Stephan Windecker, Stéphane Lafitte, Guillaume Bonnet, Roman Pfister, Arnaud Sudre, Natacha Rousse, Corentin Bourg, Guillaume L'official, Mohammed Nejjari, David Attias, Edoardo Pancaldi, Paul Achouh, Alain Berrebi, Christophe Tribouilloy, Dan Rusinaru, Christophe Saint-Etienne, Marine Mevelec, Thibault Lhermusier, Frederic Bouisset, Dimitry Schewel, Jury Schewel
Institutions: Universität Hamburg, University Medical Center Hamburg-Eppendorf, German Centre for Cardiovascular Research, Cedars-Sinai Medical Center, Cedars-Sinai Smidt Heart Institute, LMU Klinikum, Ludwig-Maximilians-Universität München, University Hospital Bonn, Deutsches Herzzentrum München, Technical University of Munich, Heart and Diabetes Center North Rhine-Westphalia, University of Bern, University Hospital of Bern, University of Cologne, University Hospital Cologne, Azienda Ospedaliera Universitaria Pisana, Centre Cardiologique du Nord, Albert Einstein College of Medicine, Montefiore Medical Center, Institut universitaire de cardiologie et de pneumologie de Québec, University of Brescia, Hôpital Européen Georges-Pompidou, Centre Hospitalier Universitaire Amiens-Picardie, Centre Hospitalier Universitaire de Tours, Centro Hospitalar de Vila Nova de Gaia, Copenhagen University Hospital, Rigshospitalet, Hôpital Rangueil, Universität Ulm, St Thomas' Hospital, Marienkrankenhaus Hamburg, Cardiovascular Research Foundation, Centre Hospitalier Universitaire de Bordeaux, Centre Hospitalier Universitaire de Rennes, Université de Rennes, Centre Hospitalier Universitaire de Lille
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,340
OpenAlex ID: W7162104197