Teer Shows Promising Outcomes In Elderly Patients With Atrial Functional Mitral Regurgitation

The mitral valve controls humor travel betwixt nan heart's near atrium and ventricle. When structural changes impact nan atrium aliases valve, it whitethorn not adjacent fully-causing humor to leak backwards, a information known arsenic atrial functional mitral regurgitation (AFMR). Common successful frail aliases aged patients, AFMR often leads to bosom failure, and modular room is typically excessively risky owed to different wellness issues.

Transcatheter edge-to-edge repair (TEER), a minimally invasive surgery, has emerged arsenic a low-risk curen action for various types of mitral regurgitation. TEER has demonstrated its efficacy by lowering nan mortality complaint successful patients pinch ventricular functional mitral regurgitation (VFMR). While some VFMR and AFMR impact nan mitral valve, their causes differ-can TEER connection nan aforesaid endurance use successful AFMR?

In a large-scale collaborative study, researchers from aggregate Japanese institutions-led by Assistant Professor Tomohiro Kaneko and Associate Professor Nobuyuki Kagiyama, some from nan Department of Cardiovascular Biology and Medicine astatine nan Juntendo University Graduate School of Medicine, Tokyo-evaluated nan relation betwixt TEER and objective outcomes successful patients pinch AFMR by comparing those who underwent TEER pinch those who received modular aesculapian therapy alone. The study was published successful nan European Heart Journal and made disposable online connected July 09, 2025. The study was co-authored by Dr. Masanori Yamamoto (Toyohashi Heart Center) and Professor Kentaro Hayashida (Keio University School of Medicine), among different experts contributing to nan registry-based research.

The study included a full of 1,081 patients pinch AFMR, pinch a mean property of 80.1 ± 8.2 years, of whom 60.5% were women. Among them, 441 patients, selected from nan OCEAN-Mitral registry, underwent TEER, while nan remaining 640 patients, chosen from nan REVEAL-AFMR registry, were nan medically managed controls. The investigation squad utilized a statistical method called propensity score-based overlap weighting to equilibrium nan characteristics of some groups, enabling an meticulous estimation of curen outcomes. The relation betwixt TEER and objective outcomes was evaluated based connected mortality and bosom failure-related hospitalizations successful patients pinch AFMR.

Patients who underwent TEER had a 35% little consequence of nan superior endpoint-a composite of all-cause mortality and hospitalization owed to bosom nonaccomplishment (hazard ratio: 0.65 [0.43–0.99]). The consequence of all-cause mortality alone, which was nan secondary endpoint, was besides 42% little (hazard ratio: 0.58 [0.35–0.99]). Survival use remained evident complete time. Even aft 3 years, nan estimated incidence of decease aliases hospitalization was 44.3% successful nan medicine group, compared to only 21.0% successful nan TEER group.

"Elderly patients pinch AFMR often autumn into a therapeutic grey zone-too high-risk for surgery, yet poorly served by aesculapian therapy alone," says first writer Dr. Kaneko. "TEER whitethorn thief reside this spread by providing a feasible, evidence-supported action that is associated pinch amended outcomes successful this susceptible population."

Outcomes were besides wished by nan grade of residual mitral regurgitation aft TEER (residual AFMR). Among patients successful whom residual AFMR was mild aliases less, nan consequence of decease aliases hospitalization was much than 50% little compared to nan medicine group. However, successful cases of mean aliases greater residual AFMR, outcomes were nary amended aliases worse than those who received aesculapian therapy alone. This suggests that nan grade of occurrence aft room is simply a cardinal determinant of nan use of TEER.

TEER occurrence was notably precocious successful nan study's Japanese cohort, pinch complete 78% achieving mild aliases little residual AFMR astatine nan clip of discharge. Only 2.9% knowledgeable immoderate complications. Moreover, factors specified arsenic age, sex, and near atrial measurement did not importantly impact nan relation betwixt TEER and favorable outcomes. However, successful cases of utmost near atrial enlargement (>100 mL/m²), this relation appeared to beryllium attenuated aliases perchance absent.

"This was an observational study, not a randomized trial, truthful unmeasured confounding cannot beryllium ruled out," notes Dr. Kaneko. "Nevertheless, we employed aggregate statistical methods to validate our findings, and nan consistency crossed analyses strengthens our assurance successful nan conclusions."

With Japan's increasing aged population, mitral regurgitation could go much prevalent. This study offers compelling grounds that TEER, erstwhile performed successfully, whitethorn correspond a promising and low-risk curen action for patients pinch AFMR who person constricted alternatives.

"In an aging world wherever frailty limits surgical choices, TEER provides a much-needed span betwixt consequence and reward," Dr. Kagiyama concluded. "Our findings support its usage arsenic a existent and promising solution for this demographic."

The authors widen their sincere appreciation to nan investigators and institutions who participated successful nan OCEAN-Mitral and REVEAL-AFMR registries. This investigation would not person been imaginable without their dedicated efforts successful information collection, diligent care, and semipermanent follow-up.