Long-term effect of transcatheter mitral valve edge-to-edge repair on left ventricular function and mitral...

Long-term outcomes of transcatheter mitral valve edge-to-edge repair (TEER) are compared with medical therapy remain under investigation. This study evaluated the 3-year effects of MitraClip on mitral regurgitation (MR) severity, ventricular remodeling, and clinical outcomes in high surgical-risk patients.

A single-center retrospective cohort included 31 MitraClip patients (2016-2023) and 30 contemporaneous controls on maximally tolerated guideline-directed medical therapy. Anatomical suitability was based on EVEREST criteria. Echocardiography was performed at baseline, 1, 2, and 3 years. Outcomes included MR severity, left ventricular ejection fraction (LVEF), right-sided parameters, biomarkers, NYHA class, 6-min walk test, heart failure (HF) hospitalizations, and all-cause mortality.

Mean age was 63.2 ± 14.5 MitraClip vs. 72.1 ± 8.9 years controls, with secondary MR in 61.3% vs. 56.7%. Severe pulmonary hypertension (SPAP > 50 mmHg) was present in 25% of primary and 55% of secondary MR patients. No procedural mortality occurred. MR improved significantly with MitraClip (93.0% mild to moderate at 1st year, 83.9% at 3rd year) while controls remained severe (p < 0.001). LVEF remained stable (~ 33-35%, p = 0.412) without correlation to MR reduction. HF hospitalizations were lower with MitraClip (58.1%, 2.1 ± 1.8 admissions) vs. controls (7.6 ± 3.2, p < 0.001). Within MitraClip, secondary MR patients had higher rates (68.4% vs. 41.7%, p = 0.042). SPAP decreased after MitraClip but rose in controls (p = 0.015). BNP declined with MitraClip but increased in controls (p = 0.01). At 3 years, more MitraClip patients were in NYHA I/II (41.9% vs. 15%), 6MWT improved while controls declined, and mortality was lower (12.9% vs. 45%, p < 0.01).

TEER provides durable MR reduction, BNP stabilization, improved functional capacity, and survival benefits compared with medical therapy in high-risk surgical patients. Primary MR patients might derive greater benefit than those with secondary MR. Larger multicenter studies are warranted.