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Impact of Prolapse Width on Outcomes of Transcatheter Edge-to-Edge Repair in Degenerative Mitral Regurgitation

Manchen Gao1, Jianrui Ma1, Yuxiang Tang2

  • 1Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, State Key Laboratory of Cardiovascular Disease, Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|December 2, 2025
PubMed

Insights

Transcatheter edge-to-edge repair (TEER) for degenerative mitral regurgitation (DMR) is optimized when prolapse width is less than 14mm. A width greater than 14mm predicts higher adverse events, regardless of clip number.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Transcatheter edge-to-edge repair (TEER) is a key treatment for high-risk degenerative mitral regurgitation (DMR).
  • The extent of leaflet lesions manageable with a single clip during TEER is not fully understood.
  • This study investigates the range of leaflet lesions treatable with one clip in DMR patients.

Purpose of the Study:

  • To determine the anatomical factors influencing successful first-clip outcomes in TEER for DMR.
  • To establish a predictive threshold for prolapse width in TEER procedures.
  • To correlate prolapse width with adverse event rates post-TEER.

Main Methods:

  • Retrospective analysis of intraoperative echocardiograms from 106 DMR patients undergoing TEER.
  • Logistic regression to identify anatomical predictors of satisfactory first-clip results.
  • Receiver-operator characteristic (ROC) curve analysis to determine optimal cut-off values for predictors.

Main Results:

  • Prolapse width and prolapse gap were independent predictors of satisfactory first-clip results.
  • Optimal prolapse width cut-off was 14mm (sensitivity 74.6%, specificity 95.3%).
  • Patients with prolapse width >14mm experienced significantly higher adverse event rates (p=0.007).

Conclusions:

  • Prolapse width is a critical predictor of TEER outcomes after the first clip.
  • A prolapse width exceeding 14mm is associated with increased postoperative severe adverse events.
  • This finding holds true irrespective of the total number of clips used in the procedure.
Abstract

Keywords:
degenerative mitral regurgitationprolapse widthtranscatheter edge‐to‐edge repair

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