Discussion
death
To date, this is the first study to describe the fate of significant iASDs post-M-TEER with serial 3D TEE to elucidate the geometrical shape of the iASD and its impact on the spontaneous closure probability.In this subgroup analysis of the MITHRAS trial, the strongest predictor for spontaneous closure was eccentricity of the iASD 1-month after M-TEER. Whereas an eccentricity index of < 1.9 predicts a persistence of the iASD 6 months post-M-TEER with great accuracy. Notably, patients with a spontaneous closure of the iASD had a numerical lower risk for HF hospitalization at 6-month follow-up.Currently, there is no guideline-based recommendation on whether or when to close a postinterventional iASD following M-TEER. In the MITHRAS trial the closure of an iASD 1-month after M-TEER did not have an effect on clinical (death / HF hospitalization) or functional outcomes at 5 months post closure. However, patients with a persistent iASD experienced worse outcomes 12-months post-M-TEER as compared to patients without an iASD post-M-TEER [