Sex-Based Differences in Outcomes After Transcatheter Edge-to-Edge Repair for Severe Mitral Regurgitation

BACKGROUND: Whether differences in outcomes exist between men and women after transcatheter edge-to-edge repair is currently unknown. OBJECTIVES: This study investigated sex-based differences in outcomes after mitral transcatheter edge-to-edge repair (M-TEER) for severe mitral regurgitation (MR). METHODS: Patients undergoing M-TEER were included from May 2014 to October 2025. The prognostic impact of sex was investigated with regard to the primary endpoint all-cause mortality at 6 months. The secondary endpoints comprised the reduction of MR, rehospitalization for heart failure (HF) and functional capacity as assessed by the 6-minute walk test. RESULTS: Of the 293 patients enrolled in the study, 119 (40.6%) were women. Compared with men, women had a similar severity of MR independent of its etiology. The prevalence of coronary artery disease (81% vs 65%; P = 0.002), and the proportion of functional MR (47% vs 37%) were higher in males. The risk of all-cause mortality at 6 months did not significantly differ in males and females (22% vs 17%; P = 0.301; adjusted OR = 0.929; 95% CI: 0.474-1.822; P = 0.830), paralleled by comparable rates of HF-related rehospitalization (10% vs 13%; P = 0.576; adjusted OR = 1.151; 95% CI: 0.520-2.548; P = 0.729). By contrast, women demonstrated a significantly lower functional capacity at baseline (P = 0.001). Interestingly, at 6 months mean improvement of functional capacity was similar between male and female patients (P = 0.778). CONCLUSIONS: Women undergoing M-TEER presented at a more advanced age and with higher symptom burden than men, potentially reflecting sex-specific clinical trajectories and differing MR etiologies. However, midterm outcomes, including all-cause mortality and HF rehospitalization, were comparable between sexes.