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CSI

MODERATED POSTER #2

(P091) EFFICACY AND SAFETY OF TRANSCATHETER MITRAL VALVE EDGE-TO-EDGE REPAIR IN REAL-WORLD CANADIAN PRACTICE: THE PREMISE REGISTRY

Thursday, October 24, 2024
1:30 PM – 2:00 PM PT
Location: Theatre 1 (Exhibit Hall)

    Author(s)

  • Neil P. Fam, MD

    Associate Professor
    University of Toronto
    University of Toronto
    Toronto, Ontario, Canada

    • First Author(s)

  • Neil P. Fam, MD

    Associate Professor
    University of Toronto
    University of Toronto
    Toronto, Ontario, Canada

    • Co-Author(s)

  • AA

    Anita W. Asgar, MD

    Associate Professor of Medicine
    University of Montreal
    Montreal, Quebec, Canada

  • Robert H. Boone, MD

    Clinical Assistant Professor
    University of British Columbia
    UBC
    Vancouver, British Columbia, Canada

  • Josep Rodés-Cabau, MD

    Professor of Medicine
    Laval University
    Laval University
    Quebec City, Quebec, Canada

  • Eric Cohen, MD

    Associate Professor
    University of Toronto
    University of Toronto
    Toronto, Ontario, Canada

  • Andrew Czarnecki, MD, MSc, FRCPC

    Assistant Professor, Department of Medicine
    University of Toronto
    University of Toronto
    Toronto, Ontario, Canada

  • ML

    Marino Labinaz, MD

    Professor of Medicine
    University of Ottawa
    Ottawa, Ontario, Canada

  • SL

    Shahar Lavi, MD

    Associate Professor
    The University of Western Ontario
    London, Ontario, Canada

  • NP

    Nicolo Piazza, n/a

    Dr.
    McGill University Health Centre
    McGill University Health Center
    Montreal, Quebec, Canada

  • Akshay Bagai, MD

    Assistant Professor
    University of Toronto
    St. Michael's Hospital
    Toronto, Ontario, Canada

  • JD Schwalm, MD, MSc

    Associate Professor of Medicine
    McMaster University
    McMaster University
    Hamilton, Ontario, Canada

  • DW

    Douglas Wright, MD

    Associate Professor
    McMaster University
    Hamilton, Ontario, Canada

  • HN

    Helen Nguyen, BSc

    Project Manager
    Population Health Research Institute
    Hamilton, Ontario, Canada

  • RM

    Rajibul Mian, PhD

    Biostatistician
    Population Health Research Institute
    Hamilton, Ontario, Canada

  • JW

    John G. Webb, MD, FRCPC

    Professor of Medicine
    CAIC
    Vancouver, British Columbia, Canada

    • Presenting Author(s)

  • SM

    Shamir R. Mehta, MD

    Professor of Medicine
    McMaster University
    McMaster Unviersity
    Hamilton, Ontario, Canada

    • Senior Author(s)

  • SM

    Shamir R. Mehta, MD

    Professor of Medicine
    McMaster University
    McMaster Unviersity
    Hamilton, Ontario, Canada

Disclosure(s):
Shamir R. Mehta, MD: No relevant disclosure to display


Background: Transcatheter mitral valve edge-to-edge repair (M-TEER) is an established treatment option for patients with severe, symptomatic mitral regurgitation (MR). The real-world experience and outcomes with M-TEER in Canada has not been previously reported.

METHODS AND RESULTS: We conducted a multicenter, observational study of 1,191 consecutive patients from 11 Canadian centers undergoing M-TEER with Mitraclip. M-TEER databases from each participating center were centrally collected. Baseline, procedural and outcome variables were mapped and merged into a single Canada-wide database. The primary efficacy outcome was MR severity before versus up to 12 months after M-TEER. Secondary outcomes were hospitalizations for heart failure (HHF) and the composite of death or HHF 12 months before versus up to 12 months after M-TEER. Results were stratified according to MR etiology (functional or degenerative).

MR etiology was functional in 62% and degenerative in 38%. The mean age was 76 (± 10) years with DMR patients being older than FMR patients (80 vs 73 years). FMR patients were more likely to have prior coronary artery disease, myocardial infarction, revascularization and chronic kidney disease. Overall, the proportion of patients with MR severity ≥ 3+ was reduced from 97.3% prior to M-TEER to 11.0% after M-TEER (absolute difference 86.4%, 95% CI 84.2-88.6, P< 0.001). Hospitalization for heart failure was 50.7% in the 12 months prior to M-TEER versus 10.2% up to 12 months after M-TEER (absolute difference 40.4%, 95% CI 36.5-44.4, P< 0.001). NYHA functional class III-IV heart failure symptoms were present in 82.8% prior to M-TEER compared with 16.6% up to 12 months after M-TEER (absolute difference 66.2%, 95% CI 62.4-70.0, P< 0.0001). Compared with before M-TEER, HHF was consistently lower up to 1 year after M-TEER in patients with functional MR (61.5% vs 9.6%, absolute difference 33.2%, P< 0.001) and degenerative MR (43.7% vs 10.5%, absolute difference 33.2%, P< 0.001). Single leaflet device attachment and need for mitral valve surgery were infrequent (1.15% and 2.3%, respectively). Mortality was 2.1% in-hospital and 13.2% at 1 year.

Conclusion: In this first national registry of M-TEER in Canada, M-TEER with Mitraclip resulted in a sustained reduction in MR up to 12 months after the procedure and was associated with clinically important reductions in heart failure hospitalizations and improvement in NYHA functional class, with a high degree of safety. This benefit was consistent in patients with functional and degenerative MR.