Transcatheter Edge-to-Edge Repair for Atrial and Ventricular Secondary Mitral Regurgitation

BACKGROUND: Secondary mitral regurgitation (SMR) has 2 phenotypes: atrial (aSMR) and ventricular (vSMR). The role of mitral valve transcatheter edge-to-edge repair (M-TEER) in aSMR remains less defined, with limited evidence on the PASCAL implant (Edwards Lifesciences). OBJECTIVES: The authors sought to evaluate and compare outcomes of SMR phenotypes undergoing M-TEER. METHODS: REPAIR (REgistry of PAscal for mItral Regurgitation) is an investigator-initiated, multicenter registry of patients undergoing M-TEER. aSMR was defined by left atrial dilation with preserved left ventricular size and ejection fraction. Outcomes included MR ≤1+ at discharge, technical success, NYHA functional class improvement, and 1-year survival. RESULTS: Among 915 patients (166 [18%] aSMR, 749 [82%] vSMR), the median follow-up was 491 days (Q1-Q3: 360-833 days). MR ≤1+ was achieved in 77.2% vs 71.4% (P = 0.162), with technical success in 97.0% vs 98.3% (P = 0.446). NYHA functional class improved in both phenotypes (P < 0.001), with 61.2% vs 61.3% in functional class ≤II at follow-up (P > 0.999). One-year survival was 88.4% (95% CI: 82.8%-94.4%) vs 86.0% (95% CI: 83.1%-89.0%; P = 0.346). In aSMR patients, 1-year survival was significantly lower in patients with baseline tricuspid regurgitation (TR) grade ≥moderate compared with those with