Key result
Very short PML (≤7 mm) had lower 1-year optimal hemodynamic durability (36% vs 66%, P<0.001) after M-TEER, though PML length did not independently predict death or HF hospitalization.
Why the study?
Does a short or very short posterior mitral leaflet length impact echocardiographic durability and clinical outcomes (all-cause death or heart failure hospitalization) compared to an adequate leaflet length in patients with functional mitral regurgitation undergoing mitral transcatheter edge-to-edge repair?
Observational (n=2,441)
Does a short or very short posterior mitral leaflet length impact echocardiographic durability and clinical outcomes (all-cause death or heart failure hospitalization) compared to an adequate leaflet length in patients with functional mitral regurgitation undergoing mitral transcatheter edge-to-edge repair?
While M-TEER is feasible in selected patients with functional MR and shorter posterior mitral leaflets without independently increasing mortality or HF hospitalization, a very short leaflet (≤7 mm) is associated with significantly worse 1-year echocardiographic durability.
Short PML may flag higher procedural risk in M-TEER; leaves open whether length should inform patient selection.
A short posterior mitral leaflet (PML) length is challenging anatomy for mitral transcatheter edge-to-edge repair (M-TEER); however, its prognostic impact remains unclear. This study evaluated the association between PML length and M-TEER outcomes. A total of 2,441 patients with functional mitral regurgitation (MR) were stratified by preprocedural PML length: very short (7 mm or less, n = 82), short (>7-10 mm, n = 736), and adequate (>10 mm, n = 1,623) groups. Procedural outcomes, echocardiographic data, and all-cause death or heart failure hospitalization were compared. Median follow-up was 14.4 months [Q1-Q3: 10.2-27.5]. At discharge, MR grade 1+ or less was comparable among the 3 groups (very short: n = 63/82, 77% vs short: n = 598/736, 81% vs adequate: n = 1,259/1,623, 78%; P = 0.129). At 1 year, MR grade numerically worsened in the very short group (MR grade 1+ or less, n = 31/52, 60%). The rate of achieving both MR grade 1+ or less and transmitral mean pressure gradient <5 mm Hg was similar among groups at discharge, but it was significantly lower in the very short group (n = 14/39, 36%) than in the short (n = 201/306, 66%) and adequate (n = 440/665, 66%) groups (P < 0.001) at 1 year. Although the incidence of the composite outcome was higher in shorter groups (P = 0.018), the PML length was not an independent risk factor in the multivariate analysis. M-TEER may be feasible in selected patients with shorter PML; however, very short PML might have less favorable echocardiographic durability, warranting anatomical assessment and follow-up. Given the small subgroup and limited follow-up, these findings require cautious interpretation and validation. OCEAN-Mitral registry (UMIN000023653).
No takes yet. Share an insight, caveat, or question.
Ono et al. (2026) conducted an observational in Functional mitral regurgitation (n=2,441). Very short posterior mitral leaflet length (≤7 mm) vs. Short (>7-10 mm) and adequate (>10 mm) posterior mitral leaflet length was evaluated on Composite of all-cause death or heart failure hospitalization; and 1-year rate of achieving both MR grade ≤1+ and transmitral mean pressure gradient <5 mm Hg (p=<0.001). Very short PML (≤7 mm) had lower 1-year optimal hemodynamic durability (36% vs 66%, P<0.001) after M-TEER, though PML length did not independently predict death or HF hospitalization.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: