Clinical Outcomes of Inpatient Mitral Transcatheter Edge-To-Edge Repair in Patients Hospitalized with Decompensated Heart Failure

Background Mitral transcatheter edge-to-edge repair (M-TEER) is an established therapy for patients with severe mitral regurgitation (MR), with randomized trials demonstrating improved outcomes in selected ambulatory populations. However, patients hospitalized with decompensated heart failure (HF) have been largely excluded from these studies, and outcomes of inpatient M-TEER remain incompletely characterized. Methods We conducted a retrospective cohort study of 149 consecutive patients who underwent M-TEER during hospitalization for decompensated HF at a tertiary care center between 2014 and 2024. The primary endpoint was 1-year all-cause mortality. Secondary endpoint was a composite of 1-year mortality or hospitalization. Multivariable logistic regression was used to identify predictors of outcomes. Results Patients were high-risk, with substantial comorbidity burden and advanced HF. MR < moderate was achieved in 83.9%. In-hospital mortality was 10.8%, increasing to 30.2% at 1 year. The composite endpoint occurred in 52.3%. Prior valve surgery and prior stroke independently predicted 1-year mortality, while prior stroke and lower left ventricular ejection fraction (LVEF) predicted the composite endpoint. Conclusions In hospitalized patients with decompensated HF, inpatient M-TEER is feasible and achieves high rates of MR reduction. However, 1-year mortality and hospitalization remains substantial and is driven primarily by comorbidities and ventricular dysfunction. Careful patient selection is critical to optimize clinical benefit.