Sex-Specific Outcomes in Patients Undergoing Mitral Valve Transcatheter Edge-to-Edge Repair: The REPAIR Study

Mitral valve transcatheter edge-to-edge repair (M-TEER) is an established treatment for patients with mitral regurgitation (MR) at prohibitive surgical risk. Sex-specific M-TEER outcomes are mainly derived from small, historic, MR etiology-specific, or MitraClip-treated cohorts.

The objective of the study was to evaluate sex-specific outcomes in patients undergoing PASCAL M-TEER.

REgistry of PAscal for mItral Regurgitation is an investigator-initiated, multicenter M-TEER registry. Outcomes included Mitral Valve Academic Research Consortium-defined technical success, optimal result at discharge (residual MR ≤ 1+ and mean transmitral pressure gradient <5 mm Hg), and 1-year all-cause mortality.

Among 2,601 patients, 1,150 (44.2%) were females and 1,451 (55.8%) were males. MR etiology distribution was similar between sexes (primary: 33.5% vs 32.4%; secondary: 48.9% vs 52.1%; mixed: 17.6% vs 15.6%; P = 0.219). Technical success was achieved in 97.0% vs 97.7% (P = 0.395). An optimal result was achieved more often in males (55.7% vs 65.9%; P < 0.001), driven by higher postprocedural gradients in females (mean transmitral valve pressure gradient ≥5 mm Hg: 24.0% vs 14.0%; P < 0.001), whereas residual mild or less MR was similar (71.3% vs 74.6%; P = 0.066). One-year mortality was 11.0% (95% CI: 8.7%-13.2%) vs 12.1% (95% CI: 10.1%-14.1%; P = 0.266). Residual mild or less MR was independently associated with lower 1-year mortality (adjusted HR: 0.57; 95% CI: 0.38-0.84; P = 0.005), whereas gradients <5 mm Hg were not (adjusted HR: 0.63; 95% CI: 0.40-1.01; P = 0.056).

PASCAL M-TEER resulted in similar technical success rates and 1-year mortality across sexes, despite females achieving an optimal result less frequently, due to higher postprocedural gradients. MR reduction to mild or less was the primary determinant of improved survival, consistent across sexes.