{
  "abstract": "Background Coaptation gap (CG) is one of the challenging anatomies of mitral transcatheter edge-to-edge repair (TEER), but its impact on patient outcomes is unclear. This study aimed to evaluate the impact of CG on procedural and clinical outcomes in patients with functional mitral regurgitation (MR).Methods Data from 2140 patients undergoing TEER for functional MR were analysed, focusing on the presence of CG, which is a missing leaflet coaptation between the anterior and posterior leaflets during systole. The primary outcome was a composite of death, heart failure hospitalisation and mitral valve reintervention.Results Of the 2140 patients, 219 (10%) had CG and 1921 (90%) did not, as assessed by baseline transoesophageal echocardiography. In patients with CG, baseline MR grade and New York Heart Association (NYHA) functional class were more severe, and long/wide clip types were used more frequently. Post-TEER, patients with CG had significantly lower achievement of MR grade ≤2+ (93%) and ≤1+ (65%) compared with patients without CG (97%, p<0.01; 82%, p<0.01, respectively). NYHA functional class at 1 year was similar in both groups. The cumulative incidence of the primary outcome was comparable between CG and non-CG groups (51% vs 53% at 3 years, p=0.71). While residual MR grade 2+ was associated with the higher primary outcome incidence compared with ≤1+ in patients without CG (p<0.01), no significant difference was found in patients with CG (p=0.51).Conclusion CG was associated with less MR reduction but with no clear difference in adverse clinical outcomes after TEER. Similar outcomes between residual MR grade 2+ and ≤1+ in CG patients highlight the importance of procedural endpoint in anatomically challenging cases.Trial registration number UMIN000023653.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan"
      ],
      "name": "Naoki Nishiura"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan"
      ],
      "name": "Shunsuke Kubo"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan"
      ],
      "name": "Sachiyo Ono"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan"
      ],
      "name": "Kazunori Mushiake"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan"
      ],
      "name": "Kohei Osakada"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan"
      ],
      "name": "Takeshi Maruo"
    },
    {
      "affiliations": [
        "Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan"
      ],
      "name": "Kazushige Kadota"
    },
    {
      "affiliations": [
        "Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan",
        "Department of Cardiology, Nagoya Heart Center, Nagoya, Japan"
      ],
      "name": "Masanori Yamamoto"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan",
        "Department of Cardiology, Toho University Faculty of Medicine Graduate School of Medicine Department of Cardiovascular Medicine, Ota, Japan"
      ],
      "name": "Mike Saji"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan"
      ],
      "name": "Yuki Izumi"
    },
    {
      "affiliations": [
        "Division of Cardiology, Mitsui Memorial Hospital, Chiyoda, Japan"
      ],
      "name": "Masahiko Asami"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan"
      ],
      "name": "Yusuke Enta"
    },
    {
      "affiliations": [
        "Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan"
      ],
      "name": "Shinichi Shirai"
    },
    {
      "affiliations": [
        "Division of Cardiology, St Marianna University School of Medicine, Kawasaki, Japan"
      ],
      "name": "Masaki Izumo"
    },
    {
      "affiliations": [
        "Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan"
      ],
      "name": "Shingo Mizuno"
    },
    {
      "affiliations": [
        "Department of Cardiology, Teikyo University School of Medicine Graduate School of Medicine, Itabashi, Japan"
      ],
      "name": "Yusuke Watanabe"
    },
    {
      "affiliations": [
        "Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan"
      ],
      "name": "Makoto Amaki"
    },
    {
      "affiliations": [
        "Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan"
      ],
      "name": "Kazuhisa Kodama"
    },
    {
      "affiliations": [
        "Department of Cardiology, Tokyo Women’s Medical University, Shinjuku, Japan"
      ],
      "name": "Junichi Yamaguchi"
    },
    {
      "affiliations": [
        "Department of Cardiology, New Tokyo Hospital, Matsudo, Japan"
      ],
      "name": "Toru Naganuma"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan"
      ],
      "name": "Hiroki Bota"
    },
    {
      "affiliations": [
        "Department of Cardiology, Tokai University School of Medicine, Isehara, Japan"
      ],
      "name": "Yohei Ohno"
    },
    {
      "affiliations": [
        "Department of Cardiology, Iryo Hojin Sapporo Heart Center Sapporo Shinzo Kekkan Clinic, Sapporo, Japan"
      ],
      "name": "Daisuke Hachinohe"
    },
    {
      "affiliations": [
        "Department of Cardiology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan"
      ],
      "name": "Masahiro Yamawaki"
    },
    {
      "affiliations": [
        "Second Department of Internal Medicine, University of Toyama University Hospital, Toyama, Japan"
      ],
      "name": "Hiroshi Ueno"
    },
    {
      "affiliations": [
        "Division of Cardiology, Kindai University Faculty of Medicine Hospital, Osakasayama, Japan"
      ],
      "name": "Kazuki Mizutani"
    },
    {
      "affiliations": [
        "Hygiene and Public Health, Nippon Medical School, Bunkyo-ku, Japan"
      ],
      "name": "Toshiaki Otsuka"
    },
    {
      "affiliations": [
        "Department of Cardiology, Keio University School of Medicine, Tokyo, Japan"
      ],
      "name": "Kentaro Hayashida"
    },
    {
      "affiliations": [],
      "name": "OCEAN-Mitral investigators"
    }
  ],
  "title": "Prognostic value of leaflet coaptation gap in transcatheter edge-to-edge repair for functional mitral regurgitation",
  "uid": "3e724852-2e5f-5e77-8230-642ec979f0fc"
}