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Why the study?
Reduction of MR in M-TEER improves patient outcomes and is balanced against elevated MVGs, prompting evaluation of the impact of residual MR and MVG on echocardiographic and clinical outcomes.
Does achieving an optimal result (MR ≤1+ and MVG ≤5 mm Hg) improve 1-year clinical outcomes compared to a suboptimal result in patients undergoing M-TEER?
RCT (n=284)
Randomized
Does achieving an optimal result (MR ≤1+ and MVG ≤5 mm Hg) improve 1-year clinical outcomes compared to a suboptimal result in patients undergoing M-TEER?
Achieving an optimal result (MR ≤1+ and MVG ≤5 mm Hg) after M-TEER is associated with significantly improved 1-year clinical outcomes, and optimizing MR reduction appears more beneficial than preserving lower gradients when both cannot be achieved.
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This suggests that the reduction of MR is a more critical determinant of prognosis than maintaining lower gradients and that strategies to reliably reduce MR to ≤1+ should be prioritized.”
Residual MR-MVG balance post-M-TEER needs clarification; leaves open optimal thresholds for practice and trials.
BACKGROUND: Reduction of mitral regurgitation (MR) in mitral transcatheter edge-to-edge repair (M-TEER) improves patient outcomes and is balanced against elevated mitral valve gradients (MVGs). OBJECTIVES: This study sought to evaluate impact of residual MR and MVG on echocardiographic and clinical outcomes post-M-TEER. METHODS: One-year outcomes from the randomized CLASP IID (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial) were analyzed by discharge MR and MVG. RESULTS: Of the 284 patients with available discharge echocardiogram, 72.5% (n = 206) achieved an optimal result (MR ≤1+ and MVG ≤5 mm Hg) and 27.5% (n = 78) achieved a suboptimal result (MR ≤1+ and MVG >5 mm Hg, MR ≥2+ and MVG ≤5 mm Hg, or MR ≥2+ and MVG >5 mm Hg). Optimal result patients had significantly improved pulmonary vein flow and tricuspid annular plane systolic excursion and experienced significantly higher freedom from major adverse events (MAEs) (89.5% vs 79.7%; P = 0.023), mortality (94.1% vs 85.4%; P = 0.016), and the composite of mortality, heart failure hospitalization, or reintervention (88.6% vs 78.7%; P = 0.022) at 1 year. Within suboptimal result patients, freedom from clinical events was higher with MR ≤1+ and MVG >5 mm Hg compared with MR ≥2+ and MVG ≤5 mm Hg at 1 year (MAEs: 87.7% vs 75.5%; mortality: 90.9% vs 84.6%; composite: 87.9% vs 72.5%). CONCLUSIONS: In the CLASP IID trial, an optimal result was associated with improved hemodynamics with significantly higher freedom from MAEs, all-cause mortality, and composite events at 1 year. Within a suboptimal result, achieving MR ≤1+ and MVG >5 mm Hg demonstrated better 1-year prognosis compared with achieving MR ≥2+ and MVG ≤5 mm Hg, suggesting a clinical benefit of optimizing MR over preserving lower gradients. (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial [CLASP IID]; NCT03706833).
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Narang et al. (2026) conducted an RCT in Mitral regurgitation (n=284). Optimal result (MR ≤1+ and MVG ≤5 mm Hg) post-M-TEER vs. Suboptimal result (MR ≤1+ and MVG >5 mm Hg, MR ≥2+ and MVG ≤5 mm Hg, or MR ≥2+ and MVG >5 mm Hg) was evaluated on Freedom from major adverse events (MAEs) at 1 year (p=0.023).
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