Determinants and prognostic impact of residual mitral regurgitation after transcatheter edge-to-edge repair
C Santos Jorge, R Barbosa Sousa, M Presume, S Azevedo, D Silva Correia, S Guerreiro, P Freitas, M Trabulo, A Felix De Oliveira, P Goncalves, E Infante Oliveira, J Brito, R Ribeiras, R Campante Teles, M AlmeidaAbstract
Background
Percutaneous edge-to-edge (E2E) transcatheter mitral repair has become an established therapeutic option for patients with moderate-to-severe or severe mitral regurgitation (MR) who are at high surgical risk. Long-term clinical outcomes and predictors of adverse events remain incompletely defined. This study aimed to characterize a real-world cohort undergoing E2E mitral repair and to identify clinical and echocardiographic factors associated with mortality and heart failure (HF) hospitalization after the procedure.
Methods
We retrospectively evaluated 107 consecutive patients deemed eligible and treated with transcatheter E2E mitral repair between 2015 and 2025 at a single center. Clinical, echocardiographic, and procedural data were collected and analyzed.
Results
The median age was 77 years (IQR 69–82), and 66 (61.7%) were male. Ischemic etiology was present in 20 (18.7%) cases, and secondary MR in 66 (61.7%). Most patients were in advanced functional class [New York Heart Association (NYHA) III–IV, 68.3%] and under diuretic therapy (n=92, 86%). The median left ventricular ejection fraction was 45% (IQR 36–55), and NT-proBNP levels were 2483 pg/mL (IQR 1090–6569). Following the intervention, MR reduction to mild was achieved in 60 (64.5%) patients. At one-year follow-up, 27 (25.2%) had required hospitalization for HF and 18 (16.8%) had died. Higher pre-procedural effective regurgitant orifice area (EROA; p =0.045) and left ventricular end-diastolic volume (p=0.029) were independently associated with more severe post procedural MR, as was the presence of atrial fibrillation (p=0.048). Increasing residual MR severity was significantly related to both HF hospitalization (p=0.013) and all-cause mortality (p=0.029). Increasing MR severity independently predicted higher NYHA classification and therefore worse functional status (p = 0.004).
Conclusions
Transcatheter E2E mitral repair led to reduction of MR severity and improvement in functional capacity. Residual MR is associated to adverse outcomes and independently linked to higher heart failure hospitalization, mortality, and poorer functional recovery. Optimizing MR reduction through careful patient selection and procedural refinement is essential to maximize long-term survival and quality-of-life benefits.For image description, please refer to the figure legend and surrounding text.