Outcome of Trans-septal Mitral Interventions in Patients with Severe Pulmonary Hypertension

Recently COAPT trail demonstrated that trans septal mitral valve repair results is survival benefit in patients with heart failure (HF) and moderate to severe or severe mitral regurgitation (MR). Such patients, not infrequently, present with severe pulmonary hypertension (SPHT) as a result of mitral valve disease and left ventricular (LV) dysfunction. However, COAPT investigators excluded patients was SPHT, defined as systolic pulmonary artery pressure (SPAP) > 70mmHg.

Aim: The purpose was to evaluate clinical and hemodynamic outcome in patients with SPHT who underwent trans-septal mitral intervention in our institution.

Methods and results: Of 44 consecutive patients with HF and moderate to severe or severe MR, 39 underwent transcatheter mitral valve repair and 5 patients, transcatheter valve in valve implantation since December 2015. Eight (18%) of patients demonstrated SPHT at baseline evaluation. Acute procedural success was achieved 39(89%) of entire cohort and in all 8 patients with severe PH. The was one case of periprocedural death and one patient required emergent surgery. The mean follow-up was 17±8 months. There was no significant difference in all-cause mortality difference between patients with no SPHT compared to those with SPHT (84% vs 83%, p=NS). Only one additional patient among SPHT group required recurrent hospitalizations for heart failure.

At 30 days compared to pre-procedual echocardiography, patients with SPHT demonstrated reduction in SPAP (79±8mmHg vs. 46±8mmHg respectively, P<0.05), and improvement in tricuspid annular plane systolic excursion (TAPSE)(14±3mm vs. 24±1mm respectively, P<0.05).

Patients with SPHT compared to those without SPHT demonstrated greater reduction in SPAP (30±13mmHg vs 9mmHg, P<0.05). and a trend to a better improvement in TAPSE (10±3mm vs. 1±4mm, p=0.07).

Conclusion: Trans septal mitral valve intervention appear to be safe and effective in patients with moderate to severe or severe MR