Evolution of Right Ventricular Function and Pulmonary Artery Coupling After Transapical Transcatheter Mitral Valve Replacement.

Impaired RV-PA coupling was highly prevalent at baseline among TMVR candidates.

• 57.4% of patients had impaired RV-PA coupling (TAPSE/sPAP < 0.4) at baseline.
• The study population comprised 195 patients from the multicentre TENDER registry.
• All patients underwent transapical TMVR with the Tendyne valve.
• Patients were those with severe mitral regurgitation not suitable for surgery or edge-to-edge repair.

One year after TMVR, systolic pulmonary artery pressure and tricuspid regurgitation severity significantly improved.

• sPAP significantly improved at 1-year follow-up.
• TR severity significantly improved at 1-year follow-up.
• These hemodynamic improvements were observed in the context of successful TMVR with the Tendyne valve.
• Both sPAP reduction and TR improvement were described as statistically significant changes.

TAPSE slightly declined while the TAPSE/sPAP ratio increased modestly at 1 year after TMVR.

• TAPSE showed a slight decline at 1-year follow-up after TMVR.
• Despite the decline in TAPSE, the TAPSE/sPAP ratio increased modestly at 1 year.
• The modest improvement in TAPSE/sPAP ratio reflects the beneficial effect of sPAP reduction counterbalancing the decline in TAPSE.
• The TAPSE/sPAP ratio was used as a marker of RV-PA coupling.

Patients with preserved baseline RV-PA coupling experienced numerically lower rates of mortality and heart failure hospitalization at 1 year, though differences did not reach statistical significance.

• The differences in mortality and heart failure hospitalization between preserved and impaired RV-PA coupling groups did not reach statistical significance.
• Patients with preserved baseline RV-PA coupling (TAPSE/sPAP ≥ 0.4) had numerically better outcomes.
• Outcomes assessed included 1-year mortality and heart failure hospitalization rates.

Reversal of pulmonary hypertension after TMVR was associated with lower risk of mortality or rehospitalization.

• Patients who achieved reversal of pulmonary hypertension had lower mortality or rehospitalization risk.
• This finding suggests that the degree of hemodynamic response to TMVR carries prognostic importance.
• Patients with failed reversal of pulmonary hypertension may require closer clinical follow-up according to the authors.

Patients with secondary MR, baseline association of impaired coupling and severe TR, or failed reversal of pulmonary hypertension were identified as higher-risk subgroups warranting closer follow-up.

• The combination of impaired RV-PA coupling and severe TR at baseline was identified as a particularly concerning finding.
• Secondary MR patients were highlighted as a subgroup potentially requiring closer clinical monitoring.
• These subgroups were identified based on analysis of the 195-patient TENDER registry cohort.
• The authors recommend further studies to validate these findings.