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Updated: Aug 5, 2026
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Real-world outcomes after simplified mitral valve transcatheter edge-to-edge repair under sole transesophageal
Jianrui Ma1, Chuangshi Wang2, Xiaofang Yan1
1Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Health Commission Key Laboratory of Cardiovascular Regeneration Medicine, Beijing, China; Key Laboratory of Innovative Cardiovascular Devices, Chinese Academy of Medical Sciences, Beijing, China.
Objective:
A simplified mitral valve transcatheter edge-to-edge repair workflow under sole transesophageal echocardiographic guidance, without fluoroscopy, has been developed. This study aimed to compare its real-world outcomes with the conventional procedures under the combined guidance of fluoroscopy and transesophageal echocardiography.
Methods:
We retrospectively analyzed 386 patients undergoing mitral valve transcatheter edge-to-edge repair between January 2021 and December 2025, including 286 in the sole transesophageal echocardiography guidance group and 100 in the combined guidance group. The primary end points were cardiovascular mortality, all-cause mortality, and a composite of all-cause mortality and heart failure hospitalization. Propensity score matching and overlap weighting were performed as sensitivity analyses.
Results:
Technical success was achieved in 98.3% and 97.0% of patients in the sole transesophageal echocardiography group and combined guidance group, respectively, and 30-day major adverse events occurred in 2.8% and 7.0%, respectively (P > .05). The median follow-up was 16.5 months. At 1 year, the estimated cumulative incidence rates of the 3 primary end points were 4.4%, 6.0%, and 11.3% in the sole transesophageal echocardiography guidance group and 6.4%, 8.5%, and 11.3% in the combined guidance group, respectively (P > .05). Mitral valve transcatheter edge-to-edge repair failure at 1 year was 4.8% and 6.3%, respectively (P > .05). The corresponding adjusted hazard ratios (95% CIs) for the 3 primary end points were 1.52 (0.61-3.79), 0.96 (0.42-2.18), and 0.93 (0.48-1.81), respectively. Findings were consistent in sensitivity and subgroup analyses.
Conclusions:
In this real-world observational cohort, mitral valve transcatheter edge-to-edge repair performed under sole transesophageal echocardiography guidance was associated with favorable procedural and follow-up outcomes, supporting the feasibility of this simplified workflow in experienced centers.
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