Key result
Recurrent mitral regurgitation after M-TEER is linked to ~43% higher all-cause mortality.
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Why the study?
Although residual MR after M-TEER is a major determinant of outcome, the prognostic impact of recurrent MR after initially successful M-TEER across degenerative and functional MR remained unclear.
Does recurrent mitral regurgitation after initially successful mitral transcatheter edge-to-edge repair increase long-term all-cause mortality in patients with degenerative or functional mitral regurgitation?
Cohort (n=461)
Does recurrent mitral regurgitation after initially successful mitral transcatheter edge-to-edge repair increase long-term all-cause mortality in patients with degenerative or functional mitral regurgitation?
Recurrent mitral regurgitation occurs in nearly one-third of patients after initially successful M-TEER and is independently associated with increased long-term mortality, particularly in those with degenerative mitral regurgitation.
BACKGROUND: Residual mitral regurgitation (MR) after mitral transcatheter edge-to-edge repair (M-TEER) is a major determinant of outcome. However, the prognostic impact of recurrent mitral regurgitation (recMR) after initially successful M-TEER remains unclear. OBJECTIVES: This study aimed to evaluate the association between recMR after successful M-TEER and long-term mortality across degenerative mitral regurgitation (DMR) and functional mitral regurgitation (FMR). METHODS: This retrospective cohort included 461 consecutive patients with MR undergoing successful M-TEER (residual mitral regurgitation ≤2+ at discharge) between 2008 and 2021. recMR was defined as ≥1-grade increase in mitral regurgitation severity at follow-up compared with discharge. The primary endpoint was all-cause mortality. RESULTS: Among 461 patients with MR undergoing M_TEER (mean age 75.0 ± 9.1 years; 60.7% male [280 of 461]; 29.3% [135 of 461] had DMR), recMR occurred in 31.7% (146 of 461) (FMR in 31.9% [104 of 326]; DMR in 31.1% [42 of 135]). The median follow-up time was 3.44 years (Q1-Q3: 1.51-3.99 years). In a 12-month landmark analysis, absence of recMR was associated with improved survival (log-rank, P = 0.0088). At 4 years, all-cause mortality was 44.8% (95% CI: 38.7%-50.3%) in patients without recMR and 56.3% (95% CI: 47.2%-63.9%) in those with recMR. In multivariable Cox regression, recMR independently predicted higher mortality (HR: 1.43; 95% CI: 1.06-1.93; P = 0.019). The survival difference was significant in patients with DMR (log-rank, P = 0.014) but not with FMR (P = 0.11). CONCLUSIONS: recMR is common and independently associated with increased mortality after M-TEER, with a more pronounced effect in patients with DMR. Identification of patients at risk may inform closer surveillance and timely reintervention.
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Pauschinger et al. (2026) conducted a cohort in Mitral regurgitation undergoing successful mitral transcatheter edge-to-edge repair (n=461). Recurrent mitral regurgitation (≥1-grade increase in MR severity at follow-up) vs. Absence of recurrent mitral regurgitation was evaluated on All-cause mortality (HR 1.43, 95% CI 1.06-1.93, p=0.019). Recurrent mitral regurgitation after successful M-TEER independently predicted higher all-cause mortality (HR 1.43; 95% CI 1.06-1.93; P=0.019), with 4-year mortality of 56.3% vs 44.8%.
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