Outcomes of Transcatheter Edge-to-Edge Repair in Patients with Atrial Functional Mitral Regurgitation: Importance of Atriogenic Tethering

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Functional mitral regurgitation (n=125). Intervention: Atrial functional mitral regurgitation (a-FMR) vs. Ventricular functional mitral regurgitation (v-FMR). Primary outcome: Major adverse cardiovascular events (MACE) at 1 year (p=0.99).

Q: What does this research mean for the field?

Transcatheter edge-to-edge repair results in comparable 1-year major adverse cardiovascular event rates between atrial and ventricular functional mitral regurgitation, though atriogenic tethering increases the risk of residual regurgitation. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Tatsuro Shoji; Masaki Izumo; Noriko Shiokawa; Taishi Okuno; Yukio Sato; Shingo Kuwata; Yuki Ishibashi; Yasuhiro Tanabe; Y Akashi

doi:10.33290/jtvt.oa.25-0014

January 1, 2026Journal of Transcatheter Valve TherapiesOpen Access

Outcomes of Transcatheter Edge-to-Edge Repair in Patients with Atrial Functional Mitral Regurgitation: Importance of Atriogenic Tethering

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Key result

Atrial and ventricular functional mitral regurgitation yield similar 1-year MACE rates after TEER.

P=0.99
n=125

Why the study?

TEER is increasingly used for functional mitral regurgitation, but outcomes comparing atrial FMR with ventricular FMR and the impact of mitral valve morphology remained to be evaluated.

Does transcatheter edge-to-edge repair (TEER) have comparable clinical and procedural outcomes in patients with atrial functional mitral regurgitation compared to ventricular functional mitral regurgitation?

Study Design

Type

Cohort (n=125)

Multicenter

No

Structured PICO

Does transcatheter edge-to-edge repair (TEER) have comparable clinical and procedural outcomes in patients with atrial functional mitral regurgitation compared to ventricular functional mitral regurgitation?

P

Population

125 patients with functional mitral regurgitation (28 with atrial, 97 with ventricular etiology) undergoing transcatheter edge-to-edge repair, followed for 1 year.

E

Exposure

Transcatheter edge-to-edge repair (TEER) using the MitraClip system

C

Comparator

Patients with ventricular functional mitral regurgitation (v-FMR) undergoing the same TEER procedure

O

Outcome

Major adverse cardiovascular events (MACE), including hospitalization owing to heart failure, stroke, and all-cause mortality, evaluated within the first yearcomposite

Main Result

Absolute Event Rate: 17.9% vs 18.6%

p-value: p=0.99

Transcatheter edge-to-edge repair (TEER) is a safe and effective treatment for atrial functional mitral regurgitation with 1-year clinical outcomes comparable to ventricular functional mitral regurgitation, though atriogenic tethering predicts higher residual regurgitation.

Limitations

Single-center, retrospective study design
Small sample size, particularly in the atriogenic tethering subgroup
Exclusion of two challenging cases from the a-FMR analysis due to mitral stenosis development during the procedure
Definition of a-FMR did not strictly require left atrial enlargement
Lack of assessment of atrial fibrillation duration and type
Short observation period of 12 months
Single-center, retrospective study
Excluded 2 challenging cases in which morphological valvular factors contributed to the development of MS during TEER
Definition of a-FMR has not been fully established and did not include left atrial enlargement as a required criterion
Lack of assessment of AF duration and type

Implication

Supports similar TEER outcomes across functional MR subtypes; leaves open randomized confirmation.

Abstract

Objective: Transcatheter edge-to-edge repair (TEER) is increasingly being used as a minimally invasive treatment option for functional mitral regurgitation (FMR). This study aimed to compare the outcomes of TEER in patients with atrial FMR (a-FMR) and ventricular FMR (v-FMR) and to assess the impact of mitral valve morphology on clinical and procedural outcomes.

Discussion

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Cite This Study

Shoji et al. (2026) conducted a cohort in Functional mitral regurgitation (n=125). Atrial functional mitral regurgitation (a-FMR) vs. Ventricular functional mitral regurgitation (v-FMR) was evaluated on Major adverse cardiovascular events (MACE) at 1 year (p=0.99). Atrial functional mitral regurgitation was associated with similar 1-year rates of major adverse cardiovascular events compared to ventricular functional mitral regurgitation (17.9% vs 18.6%) following transcatheter edge-to-edge repair.

synapsesocial.com/papers/6a9b87687cb3b62bb4a73b23 https://doi.org/10.33290/jtvt.oa.25-0014

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Outcomes of Transcatheter Edge-to-Edge Repair in Patients with Atrial Functional Mitral Regurgitation: Importance of Atriogenic Tethering

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Outcomes of Transcatheter Edge-to-Edge Repair in Patients with Atrial Functional Mitral Regurgitation: Importance of Atriogenic Tethering

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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