Predictors of early death after transcatheter edge-to-edge mitral valve repair: results from the MAVERICK registry

Background Transcatheter edge-to-edge mitral valve repair (TEER) has become an established treatment for patients with severe mitral regurgitation (MR) at high surgical risk. Given its low procedural risk, TEER is frequently offered even to the highest-risk patients, raising concerns about the lack of meaningful clinical benefit. The rate and determinants of mortality after TEER remain incompletely understood; identifying these factors could optimize patient stratification. Purpose To assess the incidence and the clinical and procedural predictors of 1-year mortality after TEER. Methods The MAVERICK registry is an international observational cohort including consecutive patients undergoing TEER across 5 centers. The primary endpoint was all-cause death at 1-year follow-up. Univariable Cox regression was performed to identify predictors of mortality. A multivariable Cox proportional hazards model was built using variables with a p-value <0.10 in the univariable analysis. Sensitivity analyses were performed according to MR etiology (organic vs. functional, with mixed mechanisms classified as functional). Results Among 824 patients that underwent TEER, 100 (12%) had died within the first year. Independent predictors of death were NYHA class III/IV (aHR 2.4, 95% CI 1.3–4.2; p=0.003), and implantation of than 3 clips (aHR 3.10, 95% CI 1.75–5.51; p<0.001). In the functional MR subgroup early mortality was 11% (59/519). NYHA class III/IV, baseline tricuspid regurgitation at least moderate, and peripheral artery disease were independent predictors of early death in this subgroup. In the organic MR subgroup, mortality was 12% (37/305); NYHA class III/IV and post-TEER MR ≥ moderate were independent predictors of early death. Conclusions Mortality at one-year post-TEER is primarily driven by baseline clinical status and procedural complexity. Advanced heart failure symptoms consistently predict mortality across all MR etiologies. Concomitant significant tricuspid regurgitation portends a worse prognosis in functional MR, and procedural success is a key driver of early survival in organic MR. These findings highlight the critical importance of optimized patient selection and procedural efficacy to improve survival following TEER.