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Stolz et al. Mini-invasive Surg 2020;4:76 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.69

Review Open Access

Predictors for procedural success and all-cause
mortality in patients undergoing transcatheter mitral

valve edge-to-edge repair for mitral regurgitation

Lukas Stolz , Martin Orban 1,2,# , Daniel Braun , Michael Nabauer , Christian Hagl , Steffen Massberg ,
3
1,2
1,2
1,#
1
Jörg Hausleiter 1,2, *, Mathias Orban *
1,2,
1 Department of Cardiology, Klinikum der Universität München - Medizinische Klinik und Poliklinik I, Munich 81377, Germany.
2 Department of Cardiology, Munich Heart Alliance - Partner Site German Center for Cardiovascular Disease (DZHK), Munich
81377, Germany.
3 Department of Cardiac Surgery, Klinikum der Universität München - Herzchirurgische Klinik und Poliklinik, Munich 81377,
Germany.
# These authors contributed equally.
*These senior authors contributed equally.
Correspondence to: Dr. Mathias Orban, Medizinische Klinik und Poliklinik I, Ludwig-Maximilians Universität München,
Marchioninistraße 15, München D 81377, Germany. E-mail: morban@med.lmu.de
How to cite this article: Stolz L, Orban M, Braun D, Nabauer M, Hagl C, Massberg S, Hausleiter J, Orban M. Predictors for
procedural success and all-cause mortality in patients undergoing transcatheter mitral valve edge-to-edge repair for mitral
regurgitation. Mini-invasive Surg 2020;4:76. http://dx.doi.org/10.20517/2574-1225.2020.69
Received: 6 Jul 2020 First Decision: 10 Aug 2020 Revised: 17 Sep 2020 Accepted: 24 Sep 2020 Published: 6 Nov 2020

Academic Editor: Azeem Latib Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
A growing body of evidence shows that transcatheter mitral valve edge-to-edge repair (TMVr) for mitral
regurgitation (MR) improves symptoms and prognosis of patients with heart failure. Still, as recently shown by
two large randomized controlled trials (COAPT and MITRA-FR), there is differing information on which patients
have the largest benefit. We aimed to summarize the current knowledge of clinical and anatomic predictors for
acute procedural failure and long-term all-cause mortality after TMVr. TMVr is an effective treatment option
for patients with symptomatic MR fulfilling certain echocardiographic and clinical criteria or being ineligible for
surgery despite optimal medical therapy. Acute procedural failure is influenced by anatomic features of the mitral
valve, among those are increased tenting and mitral valve leaflet configuration, leaflet-to-annulus index, as well
as the mitral valve opening area. In contrast, anatomy of the mitral valve plays a minor role in predicting all-cause
mortality after TMVr. This endpoint is associated with patient comorbidities (e.g., renal failure and chronic lung
disease), severe heart failure as expressed by New York Hear Association functional class (NYHA) IV, left and
right heart dysfunction, laboratory parameters (NT-proBNP), clinical scoring systems (STS and EuroScore), and
procedural MR reduction. In patients undergoing TMVr for severe MR, careful preprocedural evaluation of relevant

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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