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Secondary mitral regurgitation (SMR) significantly increases the burden on patients with heart failure. Consequently, Mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a critical intervention. This procedure effectively addresses regurgitation in patients with reduced left ventricular ejection fraction (LVEF). However, clinicians previously held limited evidence regarding its efficacy in patients with preserved LVEF. New research now explores how ventricular function and atrial remodeling dictate clinical success.
Recent retrospective analyses stratified patients based on their LVEF levels. Specifically, researchers compared those with reduced LVEF (under 50%) to those with preserved LVEF (50% or higher). Notably, the reduced LVEF group often presented with higher baseline NT-proBNP levels. These patients frequently required multiple device implants during the procedure. Despite these challenges, the technical success rate remained remarkably high at approximately 96.8% across both groups. Furthermore, the reduction in mitral regurgitation severity was consistent. Therefore, the procedure remains technically viable regardless of the patient\'s baseline ventricular function.
While technical success is high, long-term clinical outcomes vary significantly. Patients with preserved LVEF generally experience fewer major adverse cardiac and cerebrovascular events (MACCE). Interestingly, the study identified atrial remodeling as a more potent predictor of outcomes than LVEF alone. Specifically, a higher Left Atrial Volume Index (LAVi) strongly correlates with increased mortality and heart failure hospitalizations. Moreover, every unit increase in LAVi significantly elevates the risk of poor outcomes. This highlights the importance of early intervention before permanent atrial damage occurs.
Clinicians should consider both ventricular and atrial parameters when planning M-TEER. Patients with preserved LVEF, often categorized as having atrial functional mitral regurgitation, show excellent procedural responses. Additionally, managing atrial fibrillation and preventing further atrial dilation may enhance long-term survival. Similarly, these findings suggest that earlier intervention could potentially mitigate the risks associated with advanced atrial remodeling. Consequently, personalized risk stratification using echocardiographic markers like LAVi is now essential in cardiology practice.
Technical success remains consistently high across different LVEF ranges. However, patients with reduced LVEF may require more complex procedures and multiple device implants to achieve optimal regurgitation reduction.
Atrial remodeling, measured by the Left Atrial Volume Index (LAVi), is a primary predictor of long-term outcomes. Significant atrial enlargement often indicates a higher risk of heart failure hospitalization and mortality after the procedure.
Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider regarding any medical condition. Refer to the latest local and national guidelines for clinical practice.
References
Rouleau L et al. Left Ventricular Function and Atrial Remodeling Shape Outcomes After Mitral-Transcatheter Edge-to-Edge Repair. ESC Heart Fail. 2026 May 22. doi: undefined. PMID: 42172671.
Stone GW, et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018;379(24):2307-2318.
Ricciardi MJ, et al. Atrial Secondary Mitral Regurgitation Outcomes Following Mitral Transcatheter Edge-to-Edge Repair: Results From the EXPANDed Studies. JACC Cardiovasc Interv. 2024;17:2515-2526.
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