Mitral Valve Repair of Atrial Functional Mitral Regurgitation in Heart Failure with Preserved Ejection Fraction

Our objective was to describe the long-term effects of endoscopic mitral valve (MV) repair on outcome in patients with heart failure with preserved ejection fraction (HFpEF) and atrial functional mitral regurgitation (AFMR). In patients with HFpEF, even mild AFMR has been associated with poor outcome. The study population consisted of consecutive patients with HFpEF (left ventricular ejection fraction (LVEF) ≥ 50%, H2FPEF score ≥ 5) and AFMR, who underwent isolated, minimally invasive endoscopic MV repair (MVRepair group) (n = 131) or remained on standard of care (StanCare group) (n = 139). Patients with coronary artery disease or organic mitral regurgitation (MR) were excluded. Patients were matched using inverse probability of treatment weighting. Endpoints were all-cause mortality and a composite of all-cause mortality and HFpEF readmissions. The median follow-up was 5.03 years (interquartile range (IQR) 2.6–7.9 years). In the MVRepair group, the perioperative, 30-day, 1-year, and 5-year mortality were 0, 1%, 1%, and 12%, respectively. Additionally, 13 (10%) patients were readmitted for worsening HFpEF, while 2 (1%) individuals underwent redo MV surgery for recurrent MR. MVRepair compared with StanCare showed 21–29% (Standard Error (SE) 6–8%) and 19–26% (SE 6–8%) absolute risk reduction of all-cause mortality and HFpEF readmissions, respectively (all p < 0.05). MVRepair emerged as the strongest independent predictor of all-cause mortality (Hazard Ratio (HR) 0.16, 95% (Confidence Interval (CI) 0.07–0.34, p < 0.001) and HFpEF readmissions (HR 0.21, 95% CI 0.09–0.51, p < 0.001). At 5-year follow-up, in the MVRepair group, a total of 88% were alive and 80% were alive without readmission for HFpEF. We can conclude that endoscopic MV repair is associated with low perioperative mortality as well as high long-term efficacy, and appears to improve clinical outcome in patients with AFMR and HFpEF.

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Long-term systolic blood pressure and all-cause mortality in heart failure with preserved ejection fraction: an analysis of the TOPCAT trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.0983 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Huang ◽

C Liu

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Ejection Fraction ◽

Funding Source ◽

Preserved Ejection Fraction ◽

Risk Of Mortality ◽

All Cause Mortality ◽

History Of

Abstract Background Lower systolic blood pressure (SBP) at admission or discharge was associated with poor outcomes in patients with heart failure and preserved ejection fraction (HFpEF). However, the optimal long-term SBP for HFpEF was less clear. Purpose To examine the association of long-term SBP and all-cause mortality among patients with HFpEF. Methods We analyzed participants from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) study. Participants had at least two SBP measurements of different times during the follow-up were included. Long-term SBP was defined as the average of all SBP measurements during the follow-up. We stratified participants into four groups according to long-term SBP: <120mmHg, ≥120mmHg and <130mmHg, ≥130mmHg and <140mmHg, ≥140mmHg. Multivariable adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality associated with SBP level. To assess for nonlinearity, we fitted restricted cubic spline models of long-term SBP. Sensitivity analyses were conducted by confining participants with history of hypertension or those with left ventricular ejection fraction≥50%. Results The 3338 participants had a mean (SD) age of 68.5 (9.6) years; 51.4% were women, and 89.3% were White. The median long-term SBP was 127.3 mmHg (IQR 121–134.2, range 77–180.7). Patients in the SBP of <120mmHg group were older age, less often female, less often current smoker, had higher estimated glomerular filtration rate, less often had history of hypertension, and more often had chronic obstructive pulmonary disease and atrial fibrillation. After multivariable adjustment, long-term SBP of 120–130mmHg and 130–140mmHg was associated with a lower risk of mortality during a mean follow-up of 3.3 years (HR 0.65, 95% CI: 0.49–0.85, P=0.001; HR 0.66, 95% CI 0.50–0.88, P=0.004, respectively); long-term SBP of <120mmHg had similar risk of mortality (HR 1.03, 95% CI: 0.78–1.36, P=0.836), compared with long-term SBP of ≥140mmHg. Findings from restricted cubic spline analysis demonstrate that there was J-shaped association between long-term SBP and all-cause mortality (P=0.02). These association was essentially unchanged in sensitivity analysis. Conclusions Among patients with HFpEF, long-term SBP showed a J-shaped pattern with all-cause mortality and a range of 120–140 mmHg was significantly associated with better outcomes. Future randomized controlled trials need to evaluate optimal long-term SBP goal in patients with HFpEF. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): China Postdoctoral Science Foundation Grant (2019M660229 and 2019TQ0380)

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Endoscopic repair of atrial functional mitral regurgitation in heart failure: long-term effects

European Heart Journal ◽

10.1093/ehjci/ehaa946.0857 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Z Balogh ◽

T Mizukami ◽

J Bartunek ◽

C Collet ◽

M Beles ◽

...

Keyword(s):

Heart Failure ◽

Mitral Regurgitation ◽

Absolute Risk ◽

Absolute Risk Reduction ◽

Primary Objective ◽

Functional Mitral Regurgitation ◽

Long Term Effects ◽

All Cause Mortality

Abstract Introduction In patients with heart failure and preserved ejection fraction (HFpEF), even mild atrial functional mitral regurgitation (AFMR) has been associated with poor outcome. Objective To describe long-term effects of endoscopic mitral valve (MV) repair on outcome in patients with HFpEF and AFMR. Methods The study population consisted of consecutive patients with HFpEF (LVEF ≥50%, H2FPEF score ≥5) and AFMR, who underwent isolated, minimally invasive (endoscopic), MV repair (MVRepair group) (n=131) or remained on standard of care (StanCare group) (n=139). Patients with coronary artery disease or organic MR were excluded. Patients were matched using inverse probability of treatment weighting. Primary objective was all-cause mortality or HFpEF readmissions. Results The median follow up was 5.03 years (IQR 2.6–7.9 years). In the MVRepair group, the perioperative, 30-day, 1- and 5-year mortality was 0, 1% and 12%, respectively. Additional 13 (10%) patients were readmitted for worsening HFpEF, while 2 (1%) individuals underwent redo MV surgery for recurrent MR. MVRepair compared with StanCare showed 21–29% (SE 6–8%) and 19–26% (SE 6–8%) absolute risk reduction of all-cause mortality and HFpEF readmissions, respectively (all p<0.05). MVRepair emerged as the strongest independent predictor of all-cause mortality (HR 0.16, 95% CI 0.07–0.34, p<0.001) and HFpEF readmissions (HR 0.21, 95% CI 0.09–0.51, p<0.001). At 5-year follow-up, in the MVRepair group, a total of 88% were alive and 80% were alive without readmission for HFpEF. Conclusions Endoscopic MV repair is associated with low perioperative mortality, high long-term efficacy and appears to improve clinical outcome in patients with AFMR and HFpEF. Mortality and readmission for HF Funding Acknowledgement Type of funding source: None

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Functional Mitral Regurgitation in Patients with Preserved Ejection Fraction Qualified for Pulmonary Vein Isolation: A Negative Prognostic Factor for Catheter Ablation Efficacy

Medicina ◽

10.3390/medicina57080798 ◽

2021 ◽

Vol 57 (8) ◽

pp. 798

Author(s):

Małgorzata Cichoń ◽

Maciej Wybraniec ◽

Magdalena Mizia-Szubryt ◽

Katarzyna Mizia-Stec

Keyword(s):

Mitral Regurgitation ◽

Ejection Fraction ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Functional Mitral Regurgitation ◽

Preserved Ejection Fraction ◽

Long Term Follow Up ◽

The Impact

Background and Objectives: Functional mitral regurgitation (F-MR) observed in patients with atrial fibrillation could affect the effectiveness of the sinus rhythm restoring procedures. The aim of the study was to evaluate the impact of F-MR on pulmonary vein isolation (PVI) efficacy in patient with preserved ejection fraction (EF). Materials and Methods: One hundred and thirty-six patients with EF ≥ 50% (65.4% males; mean age 56 ± 11 years) with symptomatic paroxysmal or persistent AF qualified for PVI were enrolled into the study. F-MR assessment was performed in transthoracic (TTE) and transesophageal (TEE) echocardiography before the PVI procedure. PVI efficacy was evaluated in three-month and long-term follow-up. Results: F-MR was diagnosed in 74.3% patient in transthoracic echocardiography (TTE) (trace: 26.5%, mild: 43.4%, moderate: 3.7%, severe 0.7%) and 94.9% in transesophageal echocardiography (TEE) (trace: 17.6%, mild: 59.6%, moderate: 16.2%, severe: 1.5%). The PVI three-month efficacy was 75.7% in the three-month and 64% in the long-term observation. Severe F-MR in TEE at baseline was associated with lower three-month PVI efficacy (p = 0.012), while moderate to severe F-MR in TEE was related to inefficient PVI assessed in long-term follow-up (p = 0.041). Conclusions: Significant F-MR confirmed by TEE predicts three-month as well as long-term PVI efficacy.

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Catheter ablation of nonparoxysmal atrial fibrillation in patients with heart failure with reduced ejection fraction and functional mitral regurgitation

10.21203/rs.3.rs-19765/v1 ◽

2020 ◽

Author(s):

Teng Li ◽

Jun Huang ◽

Jian Liang ◽

Wenjie Peng ◽

Ligang Ding ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Mitral Regurgitation ◽

Ejection Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Functional Mitral Regurgitation ◽

Reduced Ejection Fraction

Abstract Background The optimal treatment for patients with nonparoxysmal atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) has been a subject of debate for years. We aimed to evaluate the efficacy and safety of catheter ablation (CA) of nonparoxysmal AF in patients with HFrEF and functional mitral regurgitation (MR). Methods This single-center, retrospective, and observational study enrolled 21 consecutive patients with nonparoxysmal AF, HFrEF and functional MR underwent CA༎The ablation strategy consisted of bilateral circumferential pulmonary vein isolation and empirical linear ablations. Results After a mean follow-up of 18.2 ± 8.5 months, stable sinus rhythm (SR) was achieved in 15 patients (71.4%) after the initial procedure and 17 patients (81%) after the final procedure. The NYHA class improved from 2.7 ± 0.7 before ablation to 1.2 ± 0.4 during follow-up (p < 0.001). Left ventricular ejection fraction increased from 36.5 ± 6.3% to 54.9 ± 6.6% (p < 0.001). Among 17 patients in continuous SR after the final procedure, MR severity decreased to mild or none,and 10 patients with decreased ventricular wall motion was completely restored to normal after the procedure. No serious complications occurred. Conclusion CA may be a safe and effective method for treating nonparoxysmal AF in patients with HFrEF and functional MR. It can significantly improve HF symptoms, functional MR and left ventricular function..

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Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

European Heart Journal ◽

10.1093/ehjci/ehaa946.2636 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Benito Gonzalez ◽

X Freixa ◽

C Godino ◽

M Taramasso ◽

R Estevez-Loureiro ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Functional Mitral Regurgitation ◽

Valve Repair ◽

One Year ◽

The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

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Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction

Scientific Reports ◽

10.1038/s41598-020-79729-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Pankaj Garg ◽

Hosamadin Assadi ◽

Rachel Jones ◽

Wei Bin Chan ◽

Peter Metherall ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

T1 Mapping ◽

Left Ventricular ◽

Preserved Ejection Fraction ◽

Native T1 ◽

Lv Mass ◽

All Cause Mortality ◽

Ventricular Fibrosis

AbstractCardiac magnetic resonance (CMR) is emerging as an important tool in the assessment of heart failure with preserved ejection fraction (HFpEF). This study sought to investigate the prognostic value of multiparametric CMR, including left and right heart volumetric assessment, native T1-mapping and LGE in HFpEF. In this retrospective study, we identified patients with HFpEF who have undergone CMR. CMR protocol included: cines, native T1-mapping and late gadolinium enhancement (LGE). The mean follow-up period was 3.2 ± 2.4 years. We identified 86 patients with HFpEF who had CMR. Of the 86 patients (85% hypertensive; 61% males; 14% cardiac amyloidosis), 27 (31%) patients died during the follow up period. From all the CMR metrics, LV mass (area under curve [AUC] 0.66, SE 0.07, 95% CI 0.54–0.76, p = 0.02), LGE fibrosis (AUC 0.59, SE 0.15, 95% CI 0.41–0.75, p = 0.03) and native T1-values (AUC 0.76, SE 0.09, 95% CI 0.58–0.88, p < 0.01) were the strongest predictors of all-cause mortality. The optimum thresholds for these were: LV mass > 133.24 g (hazard ratio [HR] 1.58, 95% CI 1.1–2.2, p < 0.01); LGE-fibrosis > 34.86% (HR 1.77, 95% CI 1.1–2.8, p = 0.01) and native T1 > 1056.42 ms (HR 2.36, 95% CI 0.9–6.4, p = 0.07). In multivariate cox regression, CMR score model comprising these three variables independently predicted mortality in HFpEF when compared to NTproBNP (HR 4 vs HR 1.65). In non-amyloid HFpEF cases, only native T1 > 1056.42 ms demonstrated higher mortality (AUC 0.833, p < 0.01). In patients with HFpEF, multiparametric CMR aids prognostication. Our results show that left ventricular fibrosis and hypertrophy quantified by CMR are associated with all-cause mortality in patients with HFpEF.

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Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure

Circulation Heart Failure ◽

10.1161/circheartfailure.119.006798 ◽

2020 ◽

Vol 13 (10) ◽

Cited By ~ 1

Author(s):

Kentaro Kamiya ◽

Yukihito Sato ◽

Tetsuya Takahashi ◽

Miyuki Tsuchihashi-Makaya ◽

Norihiko Kotooka ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Rehabilitation ◽

Preserved Ejection Fraction ◽

Composite Outcome ◽

Term Survival ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Related Quality

Background: Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction. Methods: This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants. Results: Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients. Conclusions: Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.

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Predictors of adverse prognosis in patients with infective endocarditis in a surgical referral center

European Heart Journal ◽

10.1093/ehjci/ehaa946.1880 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Scheggi ◽

I Olivotto ◽

N Ceschia ◽

I Merilli ◽

V Andrei ◽

...

Keyword(s):

Renal Failure ◽

Infective Endocarditis ◽

Adverse Events ◽

Ejection Fraction ◽

Relapse Rate ◽

Left Ventricular Ejection ◽

All Cause Mortality ◽

Fatal Adverse Events

Abstract Background Despite optimal medical and surgical treatment, mortality in infective endocarditis (IE) remains high. Aim of this study was to identify predictors of long term mortality for any cause, adverse event rate, relapse rate and valvular dysfunction at follow-up, in a high-volume surgical center. Methods We retrospectively analyzed 358 consecutive patients (127 women) admitted to our department with definite diagnosis of IE not device-related. IE occurred on native valves in 224 patients (63%); the infection involved the aortic valve in 192 (54%), mitral valve in 139 (39%) and tricuspid valve in 26 (7%). Overall 285 (80%) patients underwent surgery and 73 (20%) were treated conservatively, 38 due to absence of surgical indication and 35 due to refusal or prohibitive surgical risk. Long-term follow-up was obtained by structured telephone interviews. Primary endpoints were all-cause mortality, freedom from recurrent endocarditis, postoperative incidence of major adverse events (hospitalization for any cause, pace-maker implantation, new onset of atrial fibrillation, sternal dehiscence), worsening of left ventricular ejection fraction (LVEF) and valvular dysfunction. Results Mean age was 65 years (SD 15.2). Mean vegetation length was 8.9 mm (SD 7.6). Endocarditis was left-sided in 332 (93%). Average follow-up was 6 months. At univariable analysis, mortality was associated with female gender (p=0.031), age (p<0.001), higher EuroSCORE 2 (p<0.001), chronic renal failure (p<0.001), diabetes (p=0.002), brain embolism on presentation (p=0.05), double valve infection (p=0.008), low ejection fraction (p<0.001), paravalvular extension (p=0.031), prosthetic infection (p=0.018), exclusion from surgery if indicated (p<0.001), high procalcitonin levels (p=0.035); factors associated with a significantly lower mortality were streptococcal infection (p=0.04; OR 0.34) and early surgery (p=0.009, OR 0.55). At multivariable analysis independent predictors of all-cause mortality were lower EF, EuroSCORE2, procalcitonin levels and diabetes. Non-fatal adverse events were associated with renal failure (p 0.035, OR 2.8). Relapse rate was associated with S aureus infection (p=0.005, OR 3.8), right-sided endocarditis (p<0.001, OR 6.7) and drug abuse (p<0.001, OR 9.4). Conclusions The present study shows that low EF, EuroSCORE2, procalcitonin levels and diabetes are independent predictors of death in patients with IE. Non-fatal adverse events are more frequent in patients with renal failure. Relapse rate is higher in drug abusers. These informations may help personalize follow-up strategies after acute admission for IE. Funding Acknowledgement Type of funding source: None

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Functional mitral regurgitation and left atrial myopathy in heart failure with preserved ejection fraction

European Journal of Heart Failure ◽

10.1002/ejhf.1699 ◽

2020 ◽

Vol 22 (3) ◽

pp. 489-498 ◽

Cited By ~ 14

Author(s):

Maria Tamargo ◽

Masaru Obokata ◽

Yogesh N.V. Reddy ◽

Sorin V. Pislaru ◽

Grace Lin ◽

...

Keyword(s):

Heart Failure ◽

Mitral Regurgitation ◽

Ejection Fraction ◽

Left Atrial ◽

Functional Mitral Regurgitation ◽

Preserved Ejection Fraction

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1384MitraClip treatment of functional mitral regurgitation - A meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz748.0051 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Noutsias ◽

M Matiakis ◽

M Ali ◽

E Abate ◽

B Ahmadzada ◽

...

Keyword(s):

Heart Failure ◽

Mitral Regurgitation ◽

Meta Analysis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Functional Mitral Regurgitation ◽

Clinical Effects ◽

Ventricular Ejection Fraction ◽

Heart Failure Patients ◽

All Cause Mortality

Abstract Moderate-to-severe or severe functional mitral regurgitation (FMR) is associated with higher rates of hospitalizations and with increased mortality in heart failure with reduced left ventricular ejection fraction (HFrEF). Transcatheter mitral valve repair by MitraClip® implantation (TMVrMC) may effectively reduce severe MR, and is associated with symptomatic improvement. However, the long-term clinical effects of this procedure are not well defined. Aims We analyzed outcomes for rehospitalization and survival in heart failure patients with moderate-to-severe or severe functional mitral regurgitation (FMR) treated by either medical treatment (MT) only TMVrMC+MT by meta-analysis. Methods and results By systematic search of bibliographic databases, we evaluated publications comparing heart failure patients with FMR treated by MT only versus treatment by MT combined with TMVrMC. Studies with a minimum of 25 enrolled patients and a follow/up period of at least 12 months were deemed eligible for this meta-analysis. We identified n=7 studies enrolling 2,884 HFrEF patients, divided into two study arms: TMVrMC+MT (n=1,618), versus FMR patients receiving MT only (n=1,266). At 12 months, there was a significant reduction in all-cause mortality favoring TMVR+MT (OR: 0.67; CI 95% 0.55–0.81), as well as a reduction of unplanned rehospitalizations (OR: 0.69; 95%; CI 0.53–0.89), compared with the MT only patients. At 24 months, there was a significant reduction of all-cause mortality in the TMVrMC+MT patient group (OR: 0.50; CI: 95%: 0.38–0.66; p<0.001). TMVrMC+MT was associated with significantly lower rates of unplanned re-admissions for heart failure compared with MT only at 12 months (OR: 0.69; 95% CI: 0.53–0.89; p<0.001) and at 24 months (OR: 0.53; 95% CI: 0.39–0.71; p<0.001). In one publication, a survival benefit of TMVrMC+MT over MT alone was shown at 5 years post intervention (HR: 0.75; 95% CI: 0.69–0.94; p=0.012) after weighting for propensity score and controlling for age. Conclusions This meta-analysis on n=2,884 patients with moderate-to-severe or severe FMR reveals that TMVrMC+MT, as compared with MT alone, is associated with a significant reduction of rehospitalizations and improvement of survival. These data imply additional evidence for TMVrMC in eligible heart failure patients with relevant FMR, which might be important for an update of the corresponding guidelines.

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