Preprocedural New York Heart Association Class IV Independently Predicts Mortality After Effective Edge-To-Edge Repair for Primary Mitral Regurgitation
Abstract
Background: In patients with primary mitral regurgitation (MR) (PMR), advanced symptoms classified as New York Heart Association (NYHA) class IV are typically driven by valve deterioration. Transcatheter edge-to-edge repair (mitral valve transcatheter edge-to-edge repair [M-TEER]) reliably achieves effective reduction of mitral regurgitation in high-risk patients. However, whether or not preprocedural NYHA class IV continues to predict outcomes after successful MR reduction remains unclear. Methods: The Outcomes of Patients tReated wIth Mitral Transcatheter Edge-to-edge Repair for Primary Mitral Regurgitation Registry includes PMR patients undergoing M-TEER at 27 international sites between 2009 and 2023. Clinical outcomes were compared between patients in NYHA class IV and those in NYHA class II/III. Results: A total of 2528 patients were included (median age 82 years [interquartile range (IQR) 76-85], 45.9% female), and 19.7% presented in NYHA class IV. Baseline left ventricular ejection fraction and right ventricular function did not differ significantly between groups. Procedural success (residual MR <= 1+: 66.7% vs. 64.6%, p = 0.55) and 2-year rehospitalization rates (17.9% vs. 20.4%, log-rank p = 0.78) were comparable. In contrast, 2-year all-cause mortality was higher in NYHA class IV patients (31.8% vs. 21.1%, log-rank p < 0.0001). Multivariable Cox regression confirmed preprocedural NYHA class IV as an independent predictor of mortality (hazard ratio [HR] 1.75; 95% CI 1.32-2.31; p < 0.001). Conclusions: In PMR, preprocedural NYHA class IV remains an independent predictor of all-cause mortality after effective MR reduction with M-TEER, despite comparable postprocedural results.
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BibTeX
@article{koell2026preprocedural,
title = {{Preprocedural New York Heart Association Class IV Independently Predicts Mortality After Effective Edge-To-Edge Repair for Primary Mitral Regurgitation}},
author = {Benedikt Koell and Lydia Plewe and Sebastian Ludwig and Jessica Weimann and Dhairya Patel and Lukas Stolz and Tetsu Tanaka and Teresa Trenkwalder and Felix Rudolph and Daryoush Samim and Philipp von Stein and Cristina Giannini and Julien Dreyfus and Andrea Scotti and Jean-Michel Paradis and Marianna Adamo and Nicole Karam and Yohann Bohbot and Anne Bernard and Bruno Melica and Yusuke Kobari and Yoan Lavie-Badie and Mirjam Kessler and Omar Chehab and Simon Redwood and Edith Lubos and Ole de Baker and Marco Metra and Azeem Latib and Chiara Primerano and Christos Iliadis and Fabien Praz and Muhammed Gerçek and Erion Xhepa and Marcel Weber and Raj Makkar and Juan Granada and Thomas Modine and Erwan Donal and Jörg Hausleiter and Augustin Coisne and Daniel Kalbacher},
journal = {Structural Heart},
year = {2026},
month = oct,
doi = {10.1016/j.shj.2026.101053},
url = {https://hal.science/hal-05730438v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Preprocedural New York Heart Association Class IV Independently Predicts Mortality After Effective Edge-To-Edge Repair for Primary Mitral Regurgitation
AU - Benedikt Koell
AU - Lydia Plewe
AU - Sebastian Ludwig
AU - Jessica Weimann
AU - Dhairya Patel
AU - Lukas Stolz
AU - Tetsu Tanaka
AU - Teresa Trenkwalder
AU - Felix Rudolph
AU - Daryoush Samim
AU - Philipp von Stein
AU - Cristina Giannini
AU - Julien Dreyfus
AU - Andrea Scotti
AU - Jean-Michel Paradis
AU - Marianna Adamo
AU - Nicole Karam
AU - Yohann Bohbot
AU - Anne Bernard
AU - Bruno Melica
AU - Yusuke Kobari
AU - Yoan Lavie-Badie
AU - Mirjam Kessler
AU - Omar Chehab
AU - Simon Redwood
AU - Edith Lubos
AU - Ole de Baker
AU - Marco Metra
AU - Azeem Latib
AU - Chiara Primerano
AU - Christos Iliadis
AU - Fabien Praz
AU - Muhammed Gerçek
AU - Erion Xhepa
AU - Marcel Weber
AU - Raj Makkar
AU - Juan Granada
AU - Thomas Modine
AU - Erwan Donal
AU - Jörg Hausleiter
AU - Augustin Coisne
AU - Daniel Kalbacher
PY - 2026
DA - 2026/10/23
JO - Structural Heart
DO - 10.1016/j.shj.2026.101053
UR - https://hal.science/hal-05730438v1
AB - Background: In patients with primary mitral regurgitation (MR) (PMR), advanced symptoms classified as New York Heart Association (NYHA) class IV are typically driven by valve deterioration. Transcatheter edge-to-edge repair (mitral valve transcatheter edge-to-edge repair [M-TEER]) reliably achieves effective reduction of mitral regurgitation in high-risk patients. However, whether or not preprocedural NYHA class IV continues to predict outcomes after successful MR reduction remains unclear. Methods: The Outcomes of Patients tReated wIth Mitral Transcatheter Edge-to-edge Repair for Primary Mitral Regurgitation Registry includes PMR patients undergoing M-TEER at 27 international sites between 2009 and 2023. Clinical outcomes were compared between patients in NYHA class IV and those in NYHA class II/III. Results: A total of 2528 patients were included (median age 82 years [interquartile range (IQR) 76-85], 45.9% female), and 19.7% presented in NYHA class IV. Baseline left ventricular ejection fraction and right ventricular function did not differ significantly between groups. Procedural success (residual MR <= 1+: 66.7% vs. 64.6%, p = 0.55) and 2-year rehospitalization rates (17.9% vs. 20.4%, log-rank p = 0.78) were comparable. In contrast, 2-year all-cause mortality was higher in NYHA class IV patients (31.8% vs. 21.1%, log-rank p < 0.0001). Multivariable Cox regression confirmed preprocedural NYHA class IV as an independent predictor of mortality (hazard ratio [HR] 1.75; 95% CI 1.32-2.31; p < 0.001). Conclusions: In PMR, preprocedural NYHA class IV remains an independent predictor of all-cause mortality after effective MR reduction with M-TEER, despite comparable postprocedural results.
SN - 2474-8706
ER -