Sex-specific difference of long-term mortality after transcatheter edge-to-edge repair for functional mitral regurgitation; Insights from the OCEAN-Mitral Registry

BackgroundRecent studies suggested short-term mortality after transcatheter edge-to-edge repair (TEER) was comparable between male and female. However, the sex-specific prognostic difference in long-term follow-up after TEER is still unknown. To evaluate the impact of sex on long-term mortality after TEER for functional mitral regurgitation (FMR) using multicenter registry data. MethodsWe retrospectively analyzed 1220 patients (male 60.3%) who underwent TEER for FMR at 24 centers. Impact of sex on all-cause death and hospitalization for heart failure (HF) after TEER was evaluated using multivariate regression analysis and propensity score (PS) matching methods. ResultsDuring the two-year follow-up, 205 all-cause death and 259 hospitalizations for HF were observed after TEER for FMR. Male had a significantly lower incidence of all-cause death than female (18.7% vs. 14.0%, log-rank p < 0.01). After adjustment by multivariate Cox-regression and PS matching, male was significantly associated with a higher incidence of all-cause mortality after TEER than female (hazard ratio [HR] 2.24, 95% confidence interval [CI] 1.48 to 3.39 in multivariate Cox-regression; HR 2.04, 95% CI 1.17 to 3.57 in PS matching). The sex-specific prognostic difference was even more pronounced after 1-year of TEER. On contrary, there was no sex-related difference in hospitalization for HF after TEER. ConclusionsMale had a higher incidence of two-year all-cause death during after TEER for FMR than female, while this was not observed in hospitalization for HF. This result might indicate that female with FMR is more likely to benefit from TEER for better prognosis. What is known?There were conflicting results in sex-related prognostic difference after TEER for FMR. What the study addsDuring two-year follow-up period, male had higher increased risk of mortality after TEER than female in multivariate regression and propensity score matched analysis, while there was no sex-related difference in hospitalization for HF after TEER. Female with FMR might be likely to derived benefit from TEER concomitant with GDMT as compared to male.