Small Mitral Valve Orifice Area in Mitral Valve Transcatheter Edge-to-Edge Repair: The REPAIR Study

Mitral valve transcatheter edge-to-edge repair (M-TEER) is an established therapy for patients with mitral regurgitation (MR) at high surgical risk. By reducing the mitral valve orifice area (MVOA), M-TEER may increase the risk of iatrogenic mitral stenosis. Data for PASCAL M-TEER according to three-dimensional (3D)-MVOA remain limited.

To compare procedural, echocardiographic, and clinical outcomes after PASCAL M-TEER according to baseline 3D-MVOA.

Patients with available baseline 3D-MVOA from the investigator-initiated multicenter REPAIR registry were stratified by 3D-MVOA (<4 vs. ≥4 cm²). Outcomes included Mitral Valve Academic Research Consortium-defined technical success, MR ≤1+ at discharge, ≥1 New York Heart Association (NYHA) class improvement at 30-days, and 1-year all-cause mortality.

Among 1,189 patients (mean age 78±9 years, 44% female, 86% NYHA class III/IV, mean 3D-MVOA 4.9±1.6 cm², 45% secondary MR), 338 (28%) had baseline 3D-MVOA <4 cm² and 851 (72%) ≥4 cm². Technical success was achieved in 95.9% vs. 98.2% (p=0.028), and MR reduction to ≤1+ in 72% vs. 72% (p>0.999), respectively. At 30 days, NYHA class improved in 61% vs. 64% (p=0.532). One-year all-cause mortality was 13.0% (95% CI: 8.5-17.4%) vs. 13.6% (95% CI: 10.9-16.3%; p=0.760); adjusted hazard ratio (< vs. ≥ 4 cm²): 1.05 (95% CI: 0.67-1.63; p=0.842).

Almost one-third of patients with available measurements had baseline 3D-MVOA <4 cm². Technical success was modestly lower, while MR reduction and 1-year clinical outcomes did not differ significantly. These data are consistent with the feasibility of PASCAL M-TEER in carefully selected patients with small 3D-MVOA at experienced centers.