Key result
Small baseline mitral valve area shows no association with 2-year mortality after M-TEER.
Why the study?
A small baseline mitral valve area raises concern for iatrogenic mitral stenosis after M-TEER, and outcomes in patients with MVA <4.0 cm² remain limited due to trial exclusion.
Does mitral transcatheter edge-to-edge repair improve clinical outcomes in patients with moderate-to-severe or severe mitral regurgitation and a small baseline mitral valve area (<4.0 cm²)?
Cohort (n=305)
No
Does mitral transcatheter edge-to-edge repair improve clinical outcomes in patients with moderate-to-severe or severe mitral regurgitation and a small baseline mitral valve area (<4.0 cm²)?
Hazard Ratio: 0.89 (95% CI 0.6–1.33)
Absolute Event Rate: 35% vs 25.1%
p-value: p=0.59
M-TEER in patients with a small baseline mitral valve area (<4.0 cm²) is feasible and demonstrates similar 2-year mortality and heart failure hospitalization rates compared to patients with larger valve areas, supporting its use in this previously excluded high-risk population.
May support expanded M-TEER eligibility in small MVA; leaves open need for randomized confirmation before practice change.
Background: A small baseline mitral valve area (MVA) raises concern for iatrogenic mitral stenosis due to increased transmitral pressure gradients (TMPG) after mitral transcatheter edge-to-edge repair (M-TEER). Outcomes in patients with MVA <4.0 cm² remain limited, as this population has been largely excluded from clinical trials. Methods: ). The primary endpoint was 2-year all-cause mortality. Secondary endpoints included heart failure hospitalization (HFH), mitral regurgitation (MR) reduction, New York Heart Association functional class improvement, and postprocedural TMPG. Results: = 0.006). At 30 days and 1 year, mortality, HFH, and residual MR rates remained similar. Two-year Kaplan-Meier analyses showed no differences in survival, HFH, or composite outcomes. In multivariable analysis, age, creatinine, and hemoglobin predicted mortality, while age, LVEF, and hemoglobin predicted the composite outcome. Indexed MVA did not predict mortality or elevated TMPG. Conclusions: without adverse clinical outcomes through 2 years.
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Kharsa et al. (2025) conducted a cohort in Severe Mitral Regurgitation (n=305). Baseline Mitral Valve Area <4.0 cm² vs. Baseline Mitral Valve Area ≥4.0 cm² was evaluated on All-cause mortality at 2 years (HR 0.89, 95% CI 0.60-1.33, p=0.59). Baseline mitral valve area <4.0 cm² was not significantly associated with differences in 2-year all-cause mortality (HR 0.89) compared to ≥4.0 cm² in patients undergoing M-TEER.
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