Key result
In patients with ventricular functional mitral regurgitation undergoing M-TEER, very severe left ventricular dysfunction (LVEF <20%) was not associated with a significantly higher 1-year risk of all-cause death or heart failure hospitalization compared to LVEF 20-40% (HR 1.24).
Why the study?
Patients with functional MR and LVEF <20% have been largely excluded from randomized trials of M-TEER, leaving a substantial knowledge gap regarding its role in this high-risk population.
Does mitral transcatheter edge-to-edge repair (M-TEER) provide safe and effective outcomes in patients with functional mitral regurgitation and very severe LV dysfunction (LVEF <20%) compared to those with LVEF 20-40%?
Observational (n=1,538)
Yes
Does mitral transcatheter edge-to-edge repair (M-TEER) provide safe and effective outcomes in patients with functional mitral regurgitation and very severe LV dysfunction (LVEF <20%) compared to those with LVEF 20-40%?
Hazard Ratio: 1.24 (95% CI 0.82–1.88)
Absolute Event Rate: 30% vs 25%
p-value: p=0.32
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Low EF alone may not preclude consideration of M-TEER. However, persistently higher [cardiovascular] mortality and residual HF symptoms in the very severe LV dysfunction group highlight the advanced disease stage of this population and indicate that M-TEER should be viewed as a complementary stra...”
M-TEER is feasible and provides meaningful symptomatic improvement in patients with functional MR and very severe LV dysfunction (LVEF <20%), with similar 1-year rates of death or HF hospitalization compared to those with LVEF 20-40%.
BACKGROUND: Patients with functional mitral regurgitation (MR) and very severe left ventricular (LV) dysfunction (LV ejection fraction [LVEF] <20%) have been largely excluded from randomized trials of mitral transcatheter edge-to-edge repair (M-TEER), leaving a substantial knowledge gap regarding the role of M-TEER in this high-risk population. OBJECTIVES: This study aimed to evaluate the safety, feasibility, and 1-year outcomes of M-TEER in patients with functional MR and LVEF <20%. METHODS: The OCEAN (Optimized Catheter Valvular Intervention)-Mitral registry prospectively enrolled patients undergoing M-TEER. Among patients with functional MR and LVEF ≤40% (n = 1,538), outcomes were compared between those with LVEF <20% (n = 103) and 20%≤ LVEF ≤40% (n = 1,435). The primary endpoint was the composite of all-cause death and heart failure (HF) hospitalization at 1 year. Secondary endpoints included cardiovascular (CV) death and procedural outcomes. RESULTS: Acute procedural success was similar between groups (n = 103 [100%, LVEF <20%] vs n = 1,390 [97%, 20%≤ LVEF ≤40%]), with comparable residual MR and postprocedural transmitral pressure gradients. In-hospital mortality did not differ by LVEF category (n = 5 [5%] vs n = 58 [4%]). Both groups showed significant improvement in NYHA functional class at 1 year, although functional status remained worse in patients with LVEF <20%. After adjustment, the primary endpoint did not differ significantly between groups (LVEF <20% vs 20%≤ LVEF ≤40%; HR: 1.24; 95% CI: 0.82-1.88). However, LVEF <20% was independently associated with higher CV mortality (HR: 2.00; 95% CI: 1.08-3.68). CONCLUSIONS: In patients with ventricular functional MR and LVEF <20%, M-TEER was feasible and associated with meaningful symptomatic improvement without excess risk of death or HF hospitalization, although CV mortality remained higher, likely reflecting advanced myocardial disease.
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Omote et al. (2026) conducted an observational in Ventricular functional mitral regurgitation and reduced LVEF (≤40%) (n=1,538). Very severe left ventricular dysfunction (LVEF <20%) vs. LVEF 20-40% was evaluated on Composite of all-cause death and heart failure hospitalization at 1 year (HR 1.24, 95% CI 0.82-1.88, p=0.32). In patients with ventricular functional mitral regurgitation undergoing M-TEER, very severe left ventricular dysfunction (LVEF <20%) was not associated with a significantly higher 1-year risk of all-cause death or heart failure hospitalization compared to LVEF 20-40% (HR 1.24).