Doldi, Philipp MPhilipp MDoldiStolz, LukasLukasStolzKalbacher, DanielDanielKalbacherKöll, BenediktBenediktKöllGeyer, MartinMartinGeyerLudwig, SebastianSebastianLudwigOrban, MathiasMathiasOrbanBraun, DanielDanielBraunWeckbach, Ludwig TLudwig TWeckbachStocker, Thomas JThomas JStockerNäbauer, MichaelMichaelNäbauerHiguchi, SatoshiSatoshiHiguchiRuf, TobiasTobiasRufDa Rocha E Silva, JaquelineJaquelineDa Rocha E SilvaWild, MirjamMirjamWildTence, NoemieNoemieTenceUnterhuber, MatthiasMatthiasUnterhuberSchofer, NiklasNiklasSchoferPetrescu, AnielaAnielaPetrescuThiele, HolgerHolgerThieleLurz, PhilippPhilippLurzLubos, EdithEdithLubosvon Bardeleben, StephanStephanvon BardelebenKaram, NicoleNicoleKaramSamim, DaryoushDaryoushSamimParadis, Jean-MichelJean-MichelParadisIliadis, ChristosChristosIliadisXhepa, ErionErionXhepaHagl, ChristianChristianHaglMassberg, SteffenSteffenMassbergHausleiter, JörgJörgHausleiter2024-10-112024-10-112022-11https://boris-portal.unibe.ch/handle/20.500.12422/87211AIMS Right ventricular dysfunction (RVD) as expressed by right ventricular to pulmonary artery coupling has recently been identified as a strong outcome predictor in patients undergoing mitral valve edge-to-edge repair (M-TEER) for secondary mitral regurgitation. The aim of this study was to define RVD in patients undergoing M-TEER for primary MR (PMR) and to evaluate its impact on procedural MR reduction, symptomatic development and 2-year all-cause mortality. METHODS AND RESULTS This multicenter study included patients undergoing M-TEER for symptomatic PMR at 9 international centres. The study cohort was divided into a derivation (DC) and validation cohort (VC) for calculation and validation of the best discriminatory value for RVD. 648 PMR patients were included in the study. DC and VC were comparable regarding procedural success and outcomes at follow-up. Sensitivity analysis identified RVD as an independent predictor for 2-year mortality in the DC (HR: 2.37, 95%CI: 1.47-3.81, p<0.001), which was confirmed in the VC (HR: 2.06, 95%CI: 1.36-3.13, p<0.001). Procedural success (MR ≤2+) and symptomatic at follow-up (NYHA≤II) were lower in PMR patients with RVD (MR≤2+: 82% vs. 93% p=0.002; NYHA≤II: 57,3% vs. 66.5% p=0.09 for with vs. without RVD). In all PMR patients, the presence of RVD significantly impaired 2-year survival after M-TEER (HR: 2.23, 95%CI: 1.63-3.05, p<0.001). CONCLUSIONS M-TEER is an effective treatment option for PMR patients. The presence of RVD is associated with less MR reduction, less symptomatic improvement and increased 2-year mortality. Accordingly, RVD might be included into preprocedural prognostic considerations. This article is protected by copyright. All rights reserved.enEdge-to-edge repair Primary mitral valve regurgitation Right ventricular dysfunction TMVR Transcatheter mitral valve repair600 - Technology::610 - Medicine & healtharticle10.48350/1726403605455710.1002/ejhf.2661