Impact of Prolapse Width on Outcomes of Transcatheter Edge‐to‐Edge Repair in Degenerative Mitral Regurgitation

Background Transcatheter edge‐to‐edge repair (TEER) is widely used for high‐risk degenerative mitral regurgitation (DMR), but the range of leaflet lesions that can be managed with one single clip remains unclear. This study aimed to evaluate the range of leaflet lesions treatable with one clip during TEER in DMR patients. Methods We retrospectively analyzed intraoperative echocardiograms from 106 DMR patients undergoing TEER. Logistic regression was used to identify anatomical factors affecting satisfactory results after the first clip. Optimal cut‐off values were determined using Receiver‐operator characteristics (ROC) curve analysis and subsequently validated with follow‐up data. Results Forty‐three patients achieved satisfactory result after the first clip. Multivariate analysis identified prolapse width ( p < 0.001) and prolapse gap ( p = 0.039) as independent predictors for satisfactory result after the first clip. ROC analysis showed superior predictive value for prolapse width (AUC = 0.877 vs. 0.734). The optimal prolapse width cut‐off value was 14 mm when the Youden index reached maximum value of 0.699 (sensitivity 0.746, specificity 0.953). Patients with width > 14 mm had significantly higher adverse event rates (Log‐rank, Breslow, Tarone‐Ware p = 0.007, 0.007, 0.006). Consistent results were also obtained in the subgroup of patients finished TEER with 1 clip (Log‐rank, Breslow, Tarone‐Ware p = 0.065, 0.030, 0.038). Conclusions Prolapse width is a key independent predictor of outcomes after the first clip implantation in TEER procedure. The incidence of postoperative severe adverse events is higher in patients with a prolapse width exceeding 14 mm, regardless of the number of clips implanted.