Periprocedural Pulmonary Hypertension and Outcomes After Mitral Valve Transcatheter Edge-to-Edge Repair.

Authors

Junichi Miyamoto, Yohei Ohno, Satoshi Noda, Norihiko Kamioka, Tsutomu Murakami, Yuji Ikari, Shunsuke Kubo, Yuki Izumi, Mike Saji, Masanori Yamamoto, Atsushi Sugiura, Tetsuro Shimura, Masahiko Asami, Yusuke Enta, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Hisao Otsuki, Toru Naganuma, Hiroki Bota, Masahiro Yamawaki, Hiroshi Ueno, Gaku Nakazawa, Daisuke Hachinohe, Toshiaki Otsuka, Kentaro Hayashida, OCEAN-Mitral Investigators

Published in

JACC. Cardiovascular interventions. Volume 19. Issue 20. Pages 2726-2739. Oct 26, 2026.

Abstract

Pulmonary hypertension (PH) is common in patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER), but the prognostic significance of periprocedural PH changes remains uncertain.
This study sought to evaluate the association between periprocedural PH patterns and clinical outcomes after M-TEER and to identify predictors of residual and new-onset PH.
The OCEAN-Mitral registry prospectively enrolled 3,764 patients with severe mitral regurgitation treated with M-TEER. Among 3,484 patients with paired echocardiographic tricuspid regurgitation pressure gradient (TRPG) data, PH was defined as TRPG >31 mm Hg. Patients were classified as having no PH, normalized PH, new-onset PH, or residual PH according to pre- and postprocedural PH status. The primary endpoint was 2-year cardiovascular death or heart failure hospitalization. Multivariable logistic regression identified predictors of residual and new-onset PH.
No PH was observed in 1,432 patients (41.1%), normalized PH in 763 (21.9%), new-onset PH in 298 (8.6%), and residual PH in 991 (28.4%). The 2-year incidence of the primary endpoint differed significantly across groups (17.6%, 18.1%, 27.2%, and 27.6%, respectively; P < 0.001). Normalized PH showed outcomes comparable to no PH (adjusted HR: 0.98; 95% CI: 0.78-1.24). In contrast, new-onset PH (HR: 1.46; 95% CI: 1.10-1.93) and residual PH (HR: 1.37; 95% CI: 1.13-1.68) were independently associated with adverse outcomes. Severe tricuspid regurgitation, baseline TRPG >50 mm Hg, and tricuspid annular dilation predicted residual PH, whereas residual mitral regurgitation and postprocedural transmitral gradients >5 mm Hg predicted new-onset PH.
Periprocedural PH dynamics provide robust risk stratification after M-TEER, identifying low-risk patients with PH normalization and high-risk subsets with residual or new-onset PH, requiring closer surveillance and procedural optimization. Registration Treatment and Prognosis of Heart Valve Registry; UMIN-ID: UMIN000023653.

PMID:
42933915
Bibliographic data and abstract were imported from PubMed on 27 Oct 2026.

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