Procedural success after M-TEER in cancer patients: a single-center study
J Soldat, F Schindhelm, F Juergens, R Mincu, F Al Rashid, L Michel, J Kampf, A Mahabadi, T Rassaf, M TotzeckAbstract
Background
Mitral transcatheter edge-to-edge repair (M-TEER) is established in patients with severe mitral regurgitation (MR) and high operative risk. Cancer patients with severe MR are frequently considered at increased risk for surgical mitral valve repair due to tumor burden, comorbidities, and potential cardiotoxic effects of oncologic therapies. Despite the growing overlap between oncology and structural heart disease, evidence on procedural safety and outcomes of M-TEER in cancer patients remains limited.
Purpose
To evaluate and compare procedural success and post-procedural MR reduction in patients with active cancer (AC), stable cancer (SC), and no cancer undergoing M-TEER.
Methods
We retrospectively analyzed 400 consecutive patients (age 77.3 ± 10.0 years; 58.3% male) who underwent M-TEER using the PASCAL system between 2019 and 2024. Patients were stratified into three groups: no cancer (n=293), SC (n=71), and AC (n=36). We compared residual MR at discharge and follow-up, as well as procedure time, in-hospital major adverse events (MAE) defined according to the Mitral Valve Academic Research Consortium (MVARC) criteria and 1-year mortality between groups.
Results
At baseline 310 patients (77.5%) had severe MR, while the rest of the patients had moderate to severe MR. This did not differ between patients with AC, SC or no cancer (figure 1). Likewise, residual MR post procedure was comparable between groups with overall 360 patients (90%) reaching residual MR ≤ I° (figure 2). Reduction in MR remained stable upon 90 days and 1 year, again with no differences between groups (figure 3 and 4). Procedure time tended to be shorter in AC patients (75.9 ± 34.5 minutes) compared with controls (91.4 ± 48.3 minutes; p = 0.06). In-hospital MAE were infrequent in all groups (4.1% in controls, 9.9% in SC, and 2.8% in AC; p = 0.70 for AC vs. controls), and no intraprocedural mortality was observed. No significant differences in mortality were observed between the control, SC, and AC sub-groups during the first 30 days after M-TEER (1% vs. 0% vs. 0%; p = 0.58; for AC, SC and controls, respectively) and at 1 year (7.5% vs. 14.1% vs. 5.6%; p = 0.57; for AC, SC and controls, respectively).
Conclusions
M-TEER achieves high procedural success and effective MR reduction in patients with and without cancer. Cancer status, including active malignancy, does not impair immediate procedural outcomes, safety, or long-term MR reduction. These findings support M-TEER as a feasible and effective therapeutic option in cancer patients with severe MR.