Background: The impact of extra-mitral cardiac damage (EMCD) in patients undergoing mitral transcatheter edge-to-edge repair (M-TEER) for degenerative mitral regurgitation (DMR) is unknown.
Objectives: To understand M-TEER outcomes stratified by the extent of EMCD.
Methods: One-year outcomes from the randomized CLASP IID trial (NCT03706833) in prohibitive surgical risk patients with 3+/4+ DMR were analyzed by baseline EMCD stages (Stage 0: no EMCD, Stage 1: left ventricular (LV) remodeling, Stage 2: left atrial remodeling, Stage 3: pulmonary hypertension and/or tricuspid regurgitation, and Stage 4: right ventricular dysfunction.
Results: The analysis included 211 patients with 53.1% in Stages 0/1/2 (n=112), 13.3% in Stage 3 (n=28) and 33.6% in Stage 4 (n=71). Stages 0/1/2 were combined due to few patients in Stage 0 (n=3) and Stage 1 (n=1). At baseline, patients with more advanced cardiac damage had more comorbidities, lower functional and quality-of-life measures and greater MR severity. One-year rates of clinical events among all stages were comparable for major adverse events (MAEs) (P=0.343) and all-cause mortality ((P=0.644), and significantly different for heart failure hospitalization (P=0.012). Patients in all stages achieved comparable echocardiographic and quality-of-life improvements at 1 year including MRf1+ (P =0.474), LV diastolic (P=0.619) and systolic (P=0.676) volumes and KCCQ score (P=0.335), with significant improvements from baseline (all P<0.05 vs. baseline). Conclusions: Results from the CLASP IID trial demonstrate benefit of M-TEER in DMR patients across all EMCD stages, including Stage 4, with low MAEs and all-cause mortality and comparable significant improvements in echocardiographic and quality-of-life outcomes at 1 year.
Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC
CME Editor
Ragavendra R. Baliga, MD
Author
Abdullah Al-Abcha, MD
Mayra Guerrero, MD
Important Dates
Date of Release: November 10, 2025
Term of Approval/Date of CME/MOC Expiration: November 9, 2026