Transcatheter edge-to-edge repair for mitral valve regurgitation: insights from a 5-year prospective multicenter registry

Long-term data on transcatheter edge-to-edge repair (TEER) for significant mitral regurgitation (MR) remain limited. We aimed to evaluate long-term clinical outcomes and functional and echocardiographic findings during follow-up after MitraClip in a long-term subanalysis of the prospective multicenter GIOTTO registry. We included 406 consecutive patients undergoing MitraClip implantation for significant MR from 6 Italian centers contributing long-term follow-up. Baseline, procedural, in-hospital, and long-term follow-up data were compared according to MR etiology. Predictors of all-cause death were assessed using Cox regression analysis. Mean follow-up was 56.4±27.2 months. The cohort included 257 (63.3%) patients with functional or mixed MR and 149 (36.7%) with degenerative MR, who were older, more often female, and had smaller ventricles and higher LVEF, whereas functional or mixed MR patients had greater ischemic burden, conduction disease, prior revascularization, pacemaker implantation, and ventricular remodeling. During the overall observation period, crude all-cause death occurred in 161 patients (39.7%) and MVARC-style cardiovascular death in 98 (24.1%), without significant differences between groups. Mitral surgery, repeat TEER, endocarditis, and stroke occurred in 2.2%, 0.7%, 1.5%, and 3.5%, respectively. Among patients with available follow-up assessment, 77.5% were in NYHA class I/II. At the actual 5-year landmark echocardiographic assessment, 82.9% had none or mild MR and 97.1% had no more than moderate MR. Independent mortality predictors were older age, lower body mass index, right bundle branch block, MR etiology, larger LV end-systolic diameter, higher systolic pulmonary artery pressure, and longer index hospitalization (all p <0.05). In conclusion, in this prospective multicenter cohort, TEER with MitraClip in high-risk patients was associated with high procedural success and favorable long-term clinical and echocardiographic findings among patients with available follow-up. Mortality appeared to be associated with patient vulnerability, MR etiology, ventricular remodeling, pulmonary hypertension, and the early post-procedural course.