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Stolz et al. Mini-invasive Surg 2020;4:76 I http://dx.doi.org/10.20517/2574-1225.2020.69 Page 9 of 14

Table 5. Renal function: predictors for all-cause mortality after TMVr for MR
Parameter Cut-off MR etiology Ref.
GFR < 30 mL/min SMR [72]
30-60 mL/min SMR [43]
< 50 mL/min SMR [62]
* SMR [53]
* SMR/PMR [25,79]
< 60 mL/min SMR/PMR*** [44]
< 60 mL/min SMR/PMR [37,58]
Creatinine > 1.5 mg/dL SMR/PMR [35,42,57,76,87]
> 2 mg/dL SMR/PMR [27]
* SMR/PMR [83]
Renal failure ** PMR [45]
Cystatin C 1.7 mg/dL vs. 2.4 mg/dL***** SMR/PMR [89]
NGAL 132.0 ng/mL vs. 242.0 ng/mL***** SMR/PMR [89]
*Continuous parameter; **binary parameter; ***cardiac death; *****survivors vs. non survivors. TMVr: transcatheter mitral valve edge-to-
edge repair; MR: mitral regurgitation; SMR: secondary mitral regurgitation; PMR: primary mitral regurgitation; GFR: glomerular filtration
rate; NGAL: neutrophil gelatinase-associated lipocalin

Table 6. Parameters of heart failure: predictors for all-cause mortality after TMVr for MR
Parameter Cut-off MR etiology Ref.
NYHA * SMR [77]
≥ III SMR [86]
* SMR/PMR*** [80]
IV SMR/PMR*** [44]
IV SMR/PMR [37,57,58,60,76,85,87,90]
NT-proBNP ≥ 10000 pg/mL SMR [48]
3
Per 10 increase SMR (non-ischemic) [64]
Log SMR/PMR*** [80]
Log SMR/PMR [85]
≥ 5000 µg/L SMR/PMR [56]
Prior cardiac decompensation ** SMR/PMR [35,42]
Prior cardiac hospitalization ** SMR [86]
Length of hospitalization > 2 days SMR [86]
*Ordinal parameter; **binary parameter; ***cardiac death. TMVr: transcatheter mitral valve edge-to-edge repair; MR: mitral regurgitation;
SMR: secondary mitral regurgitation; PMR: primary mitral regurgitation; NYHA: New York Heart Association

SMR and composed PMR/SMR collectives. Reported cut-off values in terms of all-cause mortality range
from < 60 mL/min to < 30 mL/min for GRF and 1.5 mg/dL to 2.0 mg/dL for creatinine levels [Table 5]. In a
composed SMR/PMR collective, other laboratory parameters of kidney function including Cystatin C and
neutrophil gelatinase-associated lipocalin were also associated with worse outcome after TMVr [81,82] [Table 5].

COMORBIDITIES AND HEART FAILURE-RELATED PARAMETERS
Besides kidney function, a broad variety of clinical conditions and comorbidities are accompanied by
worse survival rates. Among those are chronic lung disease [42,83] , heart failure as expressed by elevated levels
of the natriuretic peptide NTpro-BNP [80,84] or worse New York Hear Association functional class (NYHA)
[85]
functional class [42,57,58,60,80] [Table 6], anemia [28,85] , elevated mean arterial blood pressure , impaired exercise
capacity (six minute walk test) , and peripheral artery disease [Table 7]. Integrating several of the
[42]
[74]
aforementioned conditions and comorbidities, the Society of Thoracic Surgery (STS) score as well as the
[35]
EuroScore (logistic and EuroScore II) have been shown to predict outcome after TMVr . Reported cut-
offs are ≥ 20 for logistic EuroScore and ≥ 12 for STS Score [Table 7]. As advanced age comes along with a
higher burden of comorbidities [28,62,64,80,83,86] and male patients entail a higher number of cardiac risk factors,
these demographics diminish prognosis [53,78] [Table 7].

DOES THE “IDEAL” TMVR PATIENT EXIST?
Taking into account the broad variety of cardiac and extracardiac conditions influencing outcome after
TMVr, it seems difficult to identify the “ideal” patient for this procedure. Generally speaking, survival