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Residual Mitral Regurgitation After Transcatheter Edge-to-Edge Repair Worsens Survival in Patients with Renal

Dennis Rottländer1,2, Jörg Hausleiter3,4, Thomas Schmitz5

  • 1Department of Cardiology, Faculty of Health, Witten/Herdecke University, Witten, Germany.

CJC Open
|March 2, 2026
PubMed
Abstract

Insights

Chronic kidney disease (CKD) and postprocedural acute kidney injury (AKI) significantly impact survival after mitral transcatheter edge-to-edge repair (TEER). Minimizing residual mitral regurgitation (MR) may improve outcomes for patients with CKD.

Area of Science:

  • Cardiology
  • Nephrology
  • Medical Devices

Background:

  • Chronic kidney disease (CKD) and acute kidney injury (AKI) are known predictors of mortality following transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR).
  • The interplay between residual MR, renal function, and long-term survival after TEER requires further investigation.

Purpose of the Study:

  • To evaluate the impact of residual MR on 3-year mortality in patients undergoing TEER, comparing those with and without CKD or AKI.
  • To identify risk factors for mortality in patients with varying degrees of renal function and residual MR post-TEER.

Main Methods:

  • Analysis of data from the prospective, multicentre MITRA-PRO registry (n=1491).
  • Patients were stratified by baseline estimated glomerular filtration rate (eGFR) into three groups: >50, 30-50, and <30 mL/min/1.73 m².
  • Residual MR was quantified using the MitraScore (≤3 mild; ≥4 relevant). Postprocedural AKI was also assessed.

Main Results:

  • Higher 3-year mortality was observed in patients with lower eGFR (<30 mL/min/1.73 m²; 55.4%) compared to those with eGFR 30-50 (40.8%) and >50 (27.7%).
  • Relevant residual MR was more frequent in patients with eGFR <30 (33.2%). The combination of relevant residual MR and reduced renal function was linked to worse survival.
  • Postprocedural AKI occurred in 7% of patients and was associated with increased mortality (61.5% vs 35.8%). Patients with both AKI and relevant residual MR had the highest mortality.

Conclusions:

  • Residual MR after TEER is a significant predictor of long-term mortality, especially in patients with CKD.
  • Strategies to minimize residual MR may reduce postprocedural AKI and enhance survival outcomes in patients with impaired renal function.
Keywords:
acute kidney injuryedge-to-edge repairmitral regurgitationrenal failureresidual regurgitationtranscatheter mitral valve repair

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