Recurrent Mitral Regurgitation After MitraClip: Defining Success and Predicting Outcomes

ranscatheter mitral valve (MV) edge-to-edge repair (TEER) with MitraClip (Abbott, Santa Clara, CA) has emerged over the past decade as a standard minimally invasive alternative to conventional surgical MV repair for high surgical risk patients with moderate-to-severe (+3) or severe (+4) mitral regurgitation (MR).Since the data from the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation) were revealed in 2018 followed by the US Food and Drug Administration approval of the TEER technology for secondary MR in 2019, the use of the technology has rapidly evolved to include a wider spectrum of MV pathology in parallel with improvements in the device system as well. 1 Despite these advancements, there continues to be a significant knowledge gap regarding predictors of recurrent MR following what has traditionally been considered an initially successful result of the TEER procedure with ≥50% (+2) reduction of the severity of the baseline MR.The study by Sugiura et al 2 in this issue of the journal aimed to address this important question.