Anatomical suitability and clinical outcomes of transcatheter edge-to-edge repair in Chinese patients with significant mitral regurgitation: A real-world echocardiographic study.

BACKGROUND

Data on mitral valve transcatheter edge-to-edge repair (M-TEER) in Asian patients are limited. This study evaluates the anatomical suitability and clinical efficacy of M-TEER in Chinese patients with moderate-to-severe or severe mitral regurgitation (MR).

METHODS

This study included symptomatic patients with moderate-to-severe or severe MR who underwent M-TEER echocardiographic screening at Fuwai Hospital from January 2021 to February 2024. Patients were classified according to current anatomical criteria for M-TEER. Clinical characteristics, echocardiographic parameters, and treatments were summarized, focusing on the procedural success of M-TEER and 1-year MR recurrence rates.

RESULTS

A total of 481 patients were enrolled, including 304 with degenerative MR (DMR) and 150 with functional MR (FMR). The average age was 68.81 years, 44.28 % were female, and 70.69 % had severe MR. DMR patients had smaller absolute left atrial and ventricular diameters compared to FMR patients. Ideal, suitable, challenging, and impossible M-TEER anatomy was found in 23.49 %, 36.17 %, 13.93 %, and 26.4 % of patients, respectively. Among those who underwent M-TEER, these proportions were 36 %, 46 %, 15 %, and 3 %. The 1-year cumulative incidence of MR recurrence was similar between different etiologies but significantly lower in patients with ideal/suitable anatomy compared to those with challenging/impossible anatomy (5.28 % vs 11.86 %, P = 0.003). Multivariable analysis showed that a leaflet-to-annulus index <1.2 was associated with approximately a 5.8-fold increased risk of MR recurrence within one year.

CONCLUSION

Among patients with significant MR, 59.66 % had ideal/suitable M-TEER anatomy, but only 48 % received treatment, indicating potential undertreatment. Patients with ideal/feasible anatomy had higher procedural success rates and lower recurrence risks.