What question did this study set out to answer?

The study aims to assess the safety and efficacy of a classification-guided approach to M-TEER in patients with commissural degenerative mitral regurgitation.

January 10, 2026Reviews in Cardiovascular Medicine0 citationsOpen Access

Safety and Efficacy of Novel Morphology Classification-Guided Mitral Valve Transcatheter Edge-to-Edge Repair for Patients With Commissural Degenerative Mitral Regurgitation: Design and Rationale of the TEER-CD Trial

YLYang null LiBeijing Anzhen Hospital XGXu-Nan null GuoBeijing Anzhen Hospital YWYihang null WuBeijing Anzhen Hospital

Key Result

The morphology classification system aims to improve M-TEER outcomes for patients with commissural degenerative mitral regurgitation by enabling tailored interventions.

Key Points

The study aims to assess the safety and efficacy of a classification-guided approach to M-TEER in patients with commissural degenerative mitral regurgitation.
Prospective, multicenter, single-arm design involving 12 centers in Asia.
Patients were categorized into three morphological types based on echocardiographic analysis.
Novel tailored M-TEER strategies were implemented according to morphology.
Primary endpoint focuses on achieving mitral regurgitation grade of ≤1+ without re-intervention at one year.
A total of 148 patients are required to ensure adequate statistical power for the efficacy hypothesis.

Structured PICO

Does morphology classification-guided M-TEER improve MR grade and prevent repeat mitral intervention in patients with symptomatic commissural degenerative mitral regurgitation?

Population

148 planned adult patients with symptomatic moderate-to-severe (3+) or severe (4+) native commissural degenerative mitral regurgitation (DMR) and heart failure symptoms (NYHA II-IV or asymptomatic with LVESD >40 mm).

Intervention

Morphology classification-guided mitral transcatheter edge-to-edge repair (M-TEER) using the MitraClip system (G3 or G4), with tailored clipping strategies (restrictive, simultaneous, or staged) based on 3 morphological categories.

Outcome

Proportion of subjects with mild or less MR (≤1+), without mitral valve replacement, and without recurrent mitral valve intervention (surgical or percutaneous) from the time of index procedure through 12 months.composite

The TEER-CD trial outlines a standardized morphological classification system to guide M-TEER in patients with complex commissural degenerative mitral regurgitation.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background: Mitral commissural prolapse or flail, characterized by intricate and diverse anatomical features, poses a significant challenge in mitral transcatheter edge-to-edge repair (M-TEER). Previous studies have largely focused on central mitral regurgitation with favorable valve anatomy or a general broad spectrum of complex mitral regurgitation. However, no established approach is currently available for M-TEER in commissural degenerative mitral regurgitation (DMR). Methods: Therefore, this study aimed to evaluate the efficacy and safety of a novel morphology classification-guided M-TEER strategy for treating commissural DMR using the MitraClip system. This prospective, multicenter, single-arm, objective performance criteria study involved 12 experienced centers in Asia, primarily located in China. Patients with symptomatic moderate-to-severe (3+) and severe (4+) native DMR and commissural involvement were stratified into three morphological categories based on an echocardiographic core laboratory analysis, and tailored M-TEER strategies were proposed. The primary endpoint is the proportion of patients achieving a mitral regurgitation (MR) grade of ≤1+ without repeat mitral intervention at one-year follow-up. Clinical, echocardiographic, functional, and quality-of-life outcomes were assessed over one year. Results: Based on statistical power calculations, a total of 148 patients are required to achieve adequate power to test the primary efficacy hypothesis, accounting for an estimated 10% attrition rate at 12 months. Conclusions: The morphology classification system enhances M-TEER for commissural DMR by addressing the unique challenges of this approach, enabling tailored interventions that optimize procedural success and patient outcomes. Clinical Trial Registration: ChiCTR2400090258, https://www.chictr.org.cn/showproj.html?proj=239191.

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