Postprocedural trans‐mitral gradient in patients with degenerative mitral regurgitation undergoing mitral valve transcatheter edge‐to‐edge repair

Background The relationship between high postprocedural mean gradient (ppMG) and clinical events following mitral valve transcatheter edge‐to‐edge repair (MV‐TEER) in patients with degenerative mitral regurgitation (DMR) is still debated. Aim The purpose of this study was to evaluate the effect of elevated ppMG after MV‐TEER on clinical events in patients with DMR at 1‐year follow‐up. Methods The study included 371 patients with DMR treated with MV‐TEER enrolled in the “Multi‐center Italian Society of Interventional Cardiology (GISE) registry of trans‐catheter treatment of mitral valve regurgitation” (GIOTTO) registry. Patients were stratified in tertiles according to ppMG. Primary endpoint was a composite of all‐cause death and hospitalization due to heart failure at 1‐year follow‐up. Results Patients were stratified as follows: 187 with a ppMG ≤ 3 mmHg, 77 with a ppMG > 3/=4 mmHg, and 107 with a ppMG > 4 mmHg. Clinical follow‐up was available in all subjects. At multivariate analysis, neither a ppMG > 4 mmHg nor a ppMG ≥ 5 mmHg were independently associated with the outcome. Notably, the risk of elevated residual MR (rMR > 2+) was significantly higher in patients belonging to the highest tertile of ppMG (p = 0.009). The association of ppMG > 4 mmHg and rMR ≥ 2+ was strongly and independently associated with adverse events (hazard ratio: 1.98; 95% confidence interval: [1.10–3.58]). Conclusions In a real‐world cohort of patients suffering DMR and treated with MV‐TEER, isolated ppMG was not associated with the outcome at 1‐year follow‐up. A high proportion of patients showed both elevated ppMG and rMR and their combination appeared to be a strong predictor of adverse events.