One-year Outcomes after Transcatheter Edge-to-Edge Repair in Degenerative MR Stratified by Extent of Cardiac Damage (JACC Cardiovascular Interventions November 2025)-Article: One-year Outcomes after Transcatheter Edge-to-Edge Repair in Degenerative MR Stratified by Extent of Cardiac Damage

Article: One-year Outcomes after Transcatheter Edge-to-Edge Repair in Degenerative MR Stratified by Extent of Cardiac Damage

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This study analyzed 1-year outcomes of transcatheter mitral valve edge-to-edge repair (M-TEER) in high-risk patients with severe degenerative mitral regurgitation (DMR), stratified by the extent of extramitral cardiac damage (EMCD). The analysis used data from the randomized CLASP IID trial involving 211 patients categorized into EMCD stages: stages 0-2 (no to left atrial remodeling), stage 3 (pulmonary hypertension and/or tricuspid regurgitation), and stage 4 (right ventricular dysfunction).<br /><br />At baseline, more advanced EMCD stages correlated with higher comorbidities, worse functional status, and lower quality of life. Despite these differences, procedural success rates were similarly high across all stages. Over one year, rates of major adverse events (MAE) and all-cause mortality were low and comparable regardless of EMCD stage. However, heart failure hospitalization (HFH) rates were significantly higher in stage 4 patients (12.3%) compared to stages 0-2 (2.8%) and stage 3 (0%), although after adjusting for baseline factors, this difference was not statistically significant.<br /><br />Across all EMCD stages, patients exhibited significant and comparable improvements in mitral regurgitation severity, left ventricular volumes, functional capacity (NYHA class), quality of life (Kansas City Cardiomyopathy Questionnaire score), and 6-minute walk distance at 1 year. Similarly, echocardiographic measures such as pulmonary artery pressures and left atrial size improved. Notably, these benefits were observed even among patients whose EMCD stage worsened shortly after the procedure. About half of patients had advanced EMCD (stages 3 or 4), reflecting the high-risk and symptomatic nature of the trial population.<br /><br />This study demonstrates that M-TEER offers effective clinical, echocardiographic, and quality-of-life benefits in prohibitive surgical risk DMR patients across all extents of cardiac damage, including those with severe right ventricular dysfunction. The findings support consideration of M-TEER irrespective of EMCD stage and highlight the need for further long-term studies to optimize patient selection and timing of intervention.

Keywords

transcatheter mitral valve edge-to-edge repair

M-TEER

degenerative mitral regurgitation

extramitral cardiac damage

CLASP IID trial

high-risk patients

heart failure hospitalization

echocardiographic improvements

quality of life

right ventricular dysfunction