Alabdaljabar Mohamad S, Almiro Alyaman, Khan Jibran, Gerberi Dana J, Murad M Hassan, Thaden Jeremy J, Rihal Charanjit S, Eleid Mackram F
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Catheter Cardiovasc Interv. 2025 Feb;105(2):413-425. doi: 10.1002/ccd.31321. Epub 2024 Dec 5.
Mitral transcatheter edge-to-edge repair (TEER) is a minimally invasive therapy for severe mitral regurgitation (MR) in patients with high surgical risk. TEER results in a tissue bridge that decreases mitral valve area, potentially leading to elevated mean gradient. The clinical impact of elevated gradient on outcomes is unclear.
This systematic review and meta-analysis was based on a comprehensive search of five databases. We included studies that evaluated post mitral TEER gradient on one of the following outcomes: all-cause mortality, combined endpoints, symptoms, hospitalizations, and mitral valve re-intervention. Meta-analysis was conducted using the random-effects model.
Out of 6458 citations, 17 studies were included (2017-2024) reporting on 7748 patients. There was significant heterogeneity between studies related to the cutoff used to define elevated gradient, etiology of MR, and outcomes. Elevated mitral gradient post TEER (4, 4.5, 5 mmHg) was associated with worse combined endpoint (HR = 1.35, 95% CI 1.07-1.71; I 64%), but not all-cause mortality (HR = 1.25, 95% CI 0.97-1.59; I 45%) or risk of hospitalization. For the combined endpoint, this association was mainly significant in patients who had mitral gradient assessed using discharge echocardiogram (HR = 1.39, 95% CI 1.07-1.81; I 62%) for all patients and for those with degenerative MR.
Despite the heterogeneity between studies, the current analysis suggests that patients with elevated mitral gradient post TEER are at risk of worse clinical outcomes, particularly in patients who had mitral gradient assessed using discharge transthoracic echocardiogram.
二尖瓣经导管缘对缘修复术（TEER）是一种针对手术风险高的严重二尖瓣反流（MR）患者的微创治疗方法。TEER会形成一个组织桥，减少二尖瓣面积，可能导致平均压差升高。压差升高对预后的临床影响尚不清楚。
本系统评价和荟萃分析基于对五个数据库的全面检索。我们纳入了评估二尖瓣TEER术后压差对以下结局之一影响的研究：全因死亡率、复合终点、症状、住院情况和二尖瓣再次干预。采用随机效应模型进行荟萃分析。
在6458篇文献中，纳入了17项研究（2017 - 2024年），共报告了7748例患者。研究之间在用于定义压差升高的临界值、MR的病因和结局方面存在显著异质性。TEER术后二尖瓣压差升高（4、4.5、5 mmHg）与更差的复合终点相关（HR = 1.35，95%CI 1.07 - 1.71；I² = 64%），但与全因死亡率（HR = 1.25，95%CI 0.97 - 1.59；I² = 45%）或住院风险无关。对于复合终点，这种关联主要在使用出院超声心动图评估二尖瓣压差的患者中显著（HR = 1.39，95%CI 1.07 - 1.81；I² = 62%），所有患者以及退行性MR患者均如此。
尽管研究之间存在异质性，但当前分析表明，TEER术后二尖瓣压差升高的患者临床结局较差，尤其是那些使用经胸超声心动图出院评估二尖瓣压差的患者。
