Evolution of Right Ventricular Function and Pulmonary Artery Coupling After Transapical Transcatheter Mitral Valve Replacement
Abstract
Objectives: Transcatheter mitral valve replacement (TMVR) is an emerging therapy for patients with severe mitral regurgitation (MR) who are not suitable for surgery or edge-to-edge repair. The impact of TMVR on right ventricular (RV) function and RV-pulmonary artery (PA) coupling remains poorly understood. We aimed to investigate the prognostic significance of right heart function and RV-PA coupling in TMVR recipients. Methods: This study evaluated patients from the multicentre TENDER registry entailing transapical TMVR with the Tendyne valve. We assessed RV systolic function, tricuspid regurgitation (TR), systolic PA pressure (sPAP), and the tricuspid annulus plane systolic excursion (TAPSE)/sPAP ratio as a marker of RV-PA coupling before and 1 year after TMVR. Results: Among 195 patients, 57.4% had impaired RV-PA coupling (TAPSE/sPAP < 0.4) at baseline. One year after TMVR, sPAP and TR severity significantly improved, while TAPSE slightly declined. The TAPSE/sPAP ratio increased modestly. Patients with preserved baseline RV-PA coupling experienced numerically lower rates of mortality and heart failure hospitalization at 1 year, although the differences did not reach the statistical significance. Reversal of pulmonary hypertension was associated with lower mortality or rehospitalization risk. Conclusions: RV dysfunction and impaired RV-PA coupling are frequent among TMVR candidates. They may inform risk stratification and carry prognostic significance. TMVR is associated with haemodynamic improvements that could benefit RV-PA coupling. Patients with secondary MR, with baseline association of impaired coupling and severe TR, or failed reversal of pulmonary hypertension may require closer clinical follow-up. Further studies are warranted to validate these findings.
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BibTeX
@article{anselmi2026evolution,
title = {{Evolution of Right Ventricular Function and Pulmonary Artery Coupling After Transapical Transcatheter Mitral Valve Replacement}},
author = {Amedeo Anselmi and Michaela Hell and Stephan Baldus and Anna Sonia Petronio and Tanja Rudolph and Thomas Modine and Martin Andreas Volkl and Joerg Hausleiter and Luis Nombela-Franco and Augustin Coisne and Fabien Praz and Alison Duncan and Hendrik Ruge and Lenard Conradi and Georg Nickenig and Miguel Piñón and Nicolas Dumonteil and Andreas Zierer and Marianna Adamo and Vanessa Monivas and Sebastian Barth and Francesco Maisano and Andrea Fumero and Christophe Dubois and Juan Munguira and Francesco Musumeci and Felix Kreidel and Gaby Aphram and Thomas Walther and Philip Lurz and Riccardo Gherli and Mirjam Wild and Pierre Flores and Guillaume Leurent and Ralph Stephan von Bardeleben and Erwan Donal},
journal = {European Journal of Cardio-Thoracic Surgery},
year = {2026},
month = sep,
doi = {10.1093/ejcts/ezag107},
url = {https://hal.science/hal-05587703v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Evolution of Right Ventricular Function and Pulmonary Artery Coupling After Transapical Transcatheter Mitral Valve Replacement
AU - Amedeo Anselmi
AU - Michaela Hell
AU - Stephan Baldus
AU - Anna Sonia Petronio
AU - Tanja Rudolph
AU - Thomas Modine
AU - Martin Andreas Volkl
AU - Joerg Hausleiter
AU - Luis Nombela-Franco
AU - Augustin Coisne
AU - Fabien Praz
AU - Alison Duncan
AU - Hendrik Ruge
AU - Lenard Conradi
AU - Georg Nickenig
AU - Miguel Piñón
AU - Nicolas Dumonteil
AU - Andreas Zierer
AU - Marianna Adamo
AU - Vanessa Monivas
AU - Sebastian Barth
AU - Francesco Maisano
AU - Andrea Fumero
AU - Christophe Dubois
AU - Juan Munguira
AU - Francesco Musumeci
AU - Felix Kreidel
AU - Gaby Aphram
AU - Thomas Walther
AU - Philip Lurz
AU - Riccardo Gherli
AU - Mirjam Wild
AU - Pierre Flores
AU - Guillaume Leurent
AU - Ralph Stephan von Bardeleben
AU - Erwan Donal
PY - 2026
DA - 2026/09/07
JO - European Journal of Cardio-Thoracic Surgery
DO - 10.1093/ejcts/ezag107
UR - https://hal.science/hal-05587703v1
AB - Objectives: Transcatheter mitral valve replacement (TMVR) is an emerging therapy for patients with severe mitral regurgitation (MR) who are not suitable for surgery or edge-to-edge repair. The impact of TMVR on right ventricular (RV) function and RV-pulmonary artery (PA) coupling remains poorly understood. We aimed to investigate the prognostic significance of right heart function and RV-PA coupling in TMVR recipients. Methods: This study evaluated patients from the multicentre TENDER registry entailing transapical TMVR with the Tendyne valve. We assessed RV systolic function, tricuspid regurgitation (TR), systolic PA pressure (sPAP), and the tricuspid annulus plane systolic excursion (TAPSE)/sPAP ratio as a marker of RV-PA coupling before and 1 year after TMVR. Results: Among 195 patients, 57.4% had impaired RV-PA coupling (TAPSE/sPAP < 0.4) at baseline. One year after TMVR, sPAP and TR severity significantly improved, while TAPSE slightly declined. The TAPSE/sPAP ratio increased modestly. Patients with preserved baseline RV-PA coupling experienced numerically lower rates of mortality and heart failure hospitalization at 1 year, although the differences did not reach the statistical significance. Reversal of pulmonary hypertension was associated with lower mortality or rehospitalization risk. Conclusions: RV dysfunction and impaired RV-PA coupling are frequent among TMVR candidates. They may inform risk stratification and carry prognostic significance. TMVR is associated with haemodynamic improvements that could benefit RV-PA coupling. Patients with secondary MR, with baseline association of impaired coupling and severe TR, or failed reversal of pulmonary hypertension may require closer clinical follow-up. Further studies are warranted to validate these findings.
SN - 1010-7940
SN - 1873-734X
ER -