Mitral Transcatheter Edge‐to‐Edge Repair in Patients With Advanced Heart Failure: A Single‐Center Experience and Insights Into Anatomical and Clinical Determinants of Procedural Complexity

BACKGROUND: Advanced heart failure (HF) remains a clinical challenge, and mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a potential bridging strategy. AIMS: To describe the clinical outcomes of M-TEER in a single-center cohort of patients with advanced HF and to identify anatomical and clinical features potentially associated with increased procedural complexity. METHODS: This retrospective case series included 13 consecutive patients with advanced HF and moderate-to-severe or severe mitral regurgitation (MR) who underwent M-TEER using the MitraClip system. Clinical, echocardiographic, and hemodynamic data were analyzed. RESULTS: The median age was 58 years (range 39-64), and the median EuroSCORE II was 10.4% (3.86-15.07). All patients had reduced left ventricular (LV) ejection fraction (median 22%) and enlarged LV dimensions (end-systolic diameter > 70 mm in 38%). The mean tenting height was 15.4 ± 2.5 mm. Five patients (38.4%) required continuous inotropic support. Procedural success was achieved in all cases, with no periprocedural or 30-day mortality. Over a median follow-up of 287 days (171-483), four patients (30.7%) died, one (7.6%) underwent urgent heart transplantation, and two (15.3%) had elective transplantation. Four of five patients on inotropes (80%) were weaned off support. At 1 year, 61.5% of patients remained free from the composite endpoint of death, HF hospitalization, urgent transplant, or LV assist device implantation. CONCLUSIONS: M-TEER was feasible and safe in selected patients with advanced HF. This cohort presented anatomical and clinical features that may have contributed to greater procedural complexity.