Feasibility and technical considerations of mitral TEER in adults with surgically repaired congenital heart disease: descriptive cohort of OCEAN-mitral registry.

Advances in congenital heart surgery have led to a growing population of adults with congenital heart disease (ACHD). Mitral regurgitation (MR) often develops after congenital heart surgery, yet the role and safety of transcatheter edge-to-edge repair (TEER) in this setting remain poorly defined. This descriptive cohort study from the OCEAN-Mitral registry aimed to evaluate the feasibility, procedural characteristics, and short-term outcomes of TEER in adults with surgically repaired congenital heart disease (CHD). Among 3,764 consecutive TEER cases registered between 2018 and 2023, 20 patients (0.5%) had ACHD with prior surgical repair. Baseline characteristics, procedural data, and in-hospital and 30-day outcomes were analyzed using standardized mean differences to account for unequal group sizes. Most ACHD patients (90%) had simple congenital complexity and secondary MR (70%), with preserved left ventricular function and fewer comorbidities than others. All ACHD procedures achieved acute procedural success (100%) with no major intraprocedural complications. Transseptal puncture through surgical atrial septal defect (ASD) patches was feasible and safe under transesophageal echocardiographic guidance. No patients required iatrogenic ASD closure. Hemodynamic parameters improved after TEER, with increased cardiac output and decreased left atrial V-wave pressures. In-hospital mortality and early adverse events were rare. In this descriptive cohort, TEER was technically feasible and safe in adults with surgically repaired CHD, yielding procedural and short-term outcomes comparable to those without repaired ACHD. TEER may represent a viable alternative to repeat surgery in appropriately selected ACHD when performed by experienced multidisciplinary teams.Clinical trials: OCEAN-Mitral registry (UMIN-ID: UMIN000023653).