Key result
M-TEER achieves similar outcomes across complexity groups but leaves more residual MR in primary valve disease.
Why the study?
Outcomes following M-TEER in inoperable patients with very complex or unfavorable mitral valve disease remained unknown.
Does mitral valve anatomical complexity impact MR reduction, symptomatic improvement, and survival in inoperable patients with severe mitral regurgitation undergoing transcatheter mitral valve edge-to-edge repair?
Observational (n=789)
No
Does mitral valve anatomical complexity impact MR reduction, symptomatic improvement, and survival in inoperable patients with severe mitral regurgitation undergoing transcatheter mitral valve edge-to-edge repair?
p-value: p=0.454
Mitral valve anatomical complexity does not significantly impact two-year survival or symptomatic improvement after M-TEER, though it is associated with higher residual MR in patients with primary mitral valve disease.
Similar outcomes across complexity support broader M-TEER applicability; leaves open durability of residual MR in primary disease.
Aims Mitral valve edge-to-edge repair (M-TEER) is increasingly being used for the treatment of severe mitral regurgitation, however outcomes in inoperable patients with very complex or even unfavorable mitral valve (MV) disease as „ultima ratio“are unknown. The study aimed to evaluate patient outcomes according to mitral valve anatomical complexity, as recently suggested in a recent review article stratified by MR etiology. Methods and Results In this single-center, retrospective analysis, consecutive patients who underwent M-TEER were categorized as “Non-Complex” (NC), “Complex” (C), “Very Complex” (VC) and “Ultimately Complex” (UC) M-TEER procedures. Study endpoints were MR reduction, symptomatic improvement as expressed by changes in New York Heart Association (NYHA) functional class and two-year survival. The study included 789 consecutive patients at a mean age of 74.9 ±11.1 years (42.7% female; 49% with secondary and 51% with primary or mixed MV disease). 203 patients (25.7%), 409 patients (51.8%), 138 patients (17.5%), and 39 patients (4.9%) were classified as NC, C, VC, UC, respectively. Improvement to NYHA functional class ≤II and two-year survival rates were comparable across anatomical complexity groups (NYHA≤II: 68.4%, 61.8%, 63.5%, 75.0%, p=0.454; survival: 64.6%, 71.2%, 68.0%, 71.0%; p=0.454; for NC, C, VC, UC, respectively). MR reduction was observed in all categories and it was comparable in secondary MV disease, while increasing MV complexity was associated with an increasing prevalence residual MR ≥3+ in primary MV disease (7.9%, 8.3%, 10.9%, 23.0% for NC, C, VC, UC, respectively; p=0.002). Conclusions This study provides the first large-scale validation of a recently proposed mitral valve complexity framework. Anatomical complexity showed an etiology-specific impact, with no relevant effect on MR reduction or clinical outcomes in SMR, but increasing residual MR in primary disease. Given an acceptable rate of MR reduction, M-TEER can even be considered in selected patients with unfavorable MV anatomy as “ultima ratio”.
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Hausleiter et al. (2026) conducted an observational in Severe mitral regurgitation (n=789). Mitral valve anatomical complexity vs. Non-Complex anatomy was evaluated on MR reduction, symptomatic improvement (NYHA functional class ≤II), and two-year survival (p=0.454). Increasing mitral valve anatomical complexity during M-TEER did not significantly impact two-year survival (p=0.454) but was associated with increased residual MR ≥3+ in primary disease (p=0.002).
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