Transcatheter mitral edge-to-edge repair in patients with a prior cancer diagnosis: insights from the Spanish M-TEER registry

Abstract

Introduction and objectives Among cancer survivors, mitral regurgitation (MR) may reflect therapy-related cardiotoxicity or incidental coexistence given the high prevalence of both conditions. We evaluated the efficacy and safety of mitral transcatheter edge-to-edge repair (M-TEER) in this setting. Methods We conducted a retrospective, multicenter observational study using the Spanish M-TEER registry. Patients with and without prior cancer diagnosis were matched 1:1 using propensity score matching. The primary endpoint was a composite of all-cause mortality or unplanned heart failure hospitalization at mid-term follow-up. Secondary endpoints were residual MR grade and New York Heart Association functional class at 1 year. Results Of 1237 patients (73 ± 11 years, 34% female), 164 (13.3%) had a prior cancer diagnosis. Propensity score matching yielded 163 pairs. The most common malignancies were breast (20.9%), leukemia/lymphoma (19.6%), prostate (12.9%), and colorectal (12.3%). The median [interquartile range] time from cancer diagnosis to M-TEER was 7 [3-17] years. MR was attributable to cardiotoxicity in 38.7%. MR type was associated with cancer location, anthracycline exposure, and left-sided chest radiotherapy (P < .001). After a median follow-up of 24 [11-43] months, the primary endpoint occurred in 80 (49.1%) cancer survivors and 69 (42.3%) controls (HR, 1.23; 95%CI, 0.89-1.70; P = .202). At 1-year, residual MR grade and New York Heart Association class were similar between groups. Among cancer survivors, independent predictors of worse outcomes included hematologic malignancy, mediastinal radiotherapy, diabetes mellitus, anemia, and EuroSCORE II. Conclusions A prior cancer diagnosis did not impact mid-term mortality, heart failure hospitalizations, or 1-year functional and echocardiographic outcomes after M-TEER.