Anaesthetic Strategy and Functional Outcomes During Contemporary Transcatheter Mitral Edge-to-Edge Repair: A Matched Comparison of Dexmedetomidine-Based Conscious Sedation Versus General Anaesthesia

Background Transcatheter edge-to-edge repair (M-TEER) is an established therapy for severe mitral regurgitation (MR) in patients at increased surgical risk. While procedures are commonly performed under general anaesthesia (GA), dexmedetomidine-based conscious sedation (DCS) may preserve physiological haemodynamics and improve procedural efficiency. Comparative data remain limited. Aims To compare procedural effectiveness, efficiency and safety of M-TEER performed under GA versus DCS. Methods In this retrospective observational study, patients undergoing M-TEER under anaesthesiologist-guided DCS or GA were analysed using propensity score matching to adjust for baseline differences. The primary endpoint was device effectiveness, defined as successful implantation with MR reduction to ≤2+ post-procedure and sustained at discharge. Procedural duration was analysed as a secondary workflow endpoint. The main safety endpoint was a composite of all-cause death, stroke, cardiac structural complications, cardiogenic shock, acute kidney injury requiring renal replacement therapy, or moderate/severe bleeding according to Mitral Valve Academic Research Consortium criteria. Results Ninety-seven patients were included (DCS 37; GA 60). Device implantation success was achieved in 98.9% of procedures. Immediate device effectiveness was high and comparable between strategies (100% vs. 98.3%; p=1.0). Procedural duration was shorter with DCS (84 [IQR 70.5–111.5] vs. 102.5 [78–144] min; p=0.019). In matched analysis (36 pairs), fluoroscopy time, radiation dose, and residual MR at discharge (MR≤1: 86.1% vs. 83.3%; p=0.743) were similar. The composite safety endpoint did not differ significantly (p=0.436), and no surgical conversions occurred. Conclusions Dexmedetomidine-based conscious sedation provided procedural effectiveness and safety comparable to GA while improving procedural efficiency. These findings support an individualized anaesthetic strategy and warrant prospective evaluation in contemporary M-TEER practice.