Mitral valve regurgitation: emerging therapies and their long-term impact

Introduction

Mitral regurgitation (MR) can significantly impair patients’ quality of life and, without timely intervention, may progress to heart failure and increase the risk of death. In recent years, transcatheter edge-to-edge mitral valve repair (MTEER) and transcatheter mitral valve replacement (TMVR) have emerged as an important therapeutic strategy.

Aim

To examine the clinical course of patients with moderate-to-severe or severe MR and to determine the impact of percutaneous treatment on cardiovascular hospitalization and mortality.

Methods

Single center retrospective analysis of patients with moderate-to-severe or severe MR demonstrated in transesophageal echocardiogram (TOE) performed between 2016 to 2025. We evaluated baseline characteristics and whether patients were treated with surgery, percutaneously or conservative management. The primary outcome was a composite of cardiovascular hospitalization and mortality. Secondary outcomes included the individual components of the primary outcome, NYHA class, NTproBNP levels, and furosemide dose at 1y-follow-up.

Results

A total of 362 patients were included (63% male; median age 77 years [IQR 67–84] and median EuroScore 3.2 [IQR 1.9–5.0]). Most patients had severe MR (75%, n=82). Based on etiologic classification, 63% (n=226) had primary MR, 30% (n=109) had secondary MR, and 7% (n=27) had mixed etiology.

In the group of patients referred for surgery (n=127, 35%), individuals were younger (p<0.001), had a lower median EuroScore (p<0.001) and median NT-proBNP levels (p=0.002), fewer presented with NYHA class III–IV (p<0.001) and most had primary MR (92%, n=117). Consequently, they had less primary outcome events at 1y (9%, p<0.001), with no cardiovascular hospitalizations.

In the group of patients treated percutaneously (n=109, 30%), MTEER was performed in 100 patients and 9 underwent TMVR. Compared with the conservatively treated group (n=126, 35%), patients receiving percutaneous therapy were more frequently ischemic (p=0.006) with secondary MR etiology (p<0.001), more symptomatic (p<0.001) and requiring higher furosemide doses (p=0.009). At 1-year follow-up, the percutaneous treatment group had lower mortality (12% vs 26%, p=0.006). There were no significant differences in the primary outcome, cardiovascular hospitalizations or other secondary outcomes.

However, at 1-year follow-up after percutaneous treatment, patients showed a significant reduction in MR severity (p<0.001), NYHA class (p<0.001), and furosemide dose (p=0.001), with no significant change in NT-proBNP levels (p=0.558). In contrast, patients managed conservatively experienced an increase in NT-proBNP (p<0.001), worsening NYHA class (p<0.001), and a higher furosemide dose (p=0.029).

Conclusions

M-TEER and TMVR proved to be safe procedures that can save lives and improve quality of life when applied in carefully selected candidates.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.