Transcatheter edge-to-edge (E2E) mitral repair has become an established treatment option for patients with moderate-to-severe or severe mitral regurgitation (MR) who are at high surgical risk. A retrospective single-center study presented at EuroPCR 2026 evaluated predictors of residual MR and their association with long-term clinical outcomes after transcatheter E2E mitral repair.

The analysis included 107 consecutive patients treated between 2015 and 2025. Clinical, echocardiographic, and procedural characteristics were evaluated to identify factors associated with postprocedural MR severity, mortality, and heart failure (HF) hospitalization.
Median patient age was 77 years, 61.7% were male, and 61.7% had secondary MR. Most patients had advanced symptoms, with 68.3% classified as New York Heart Association (NYHA) class III or IV before intervention.

Findings

• MR reduction to mild severity after TEER was achieved in 64.5% of patients.
• At 1-year follow-up, HF hospitalization occurred in 25.2% of patients and all-cause mortality in 16.8%.
• Higher preprocedural EROA (P = 0.045) and larger left ventricular end-diastolic volume (P = 0.029) were independently associated with more severe residual MR.
• Atrial fibrillation was independently associated with greater postprocedural MR severity (P = 0.048).
• Increasing residual MR severity was significantly associated with higher HF hospitalization (P = 0.013), all-cause mortality (P = 0.029), and worse functional status reflected by higher NYHA class (P = 0.004).

Residual MR after transcatheter E2E mitral repair was associated with higher HF hospitalization, mortality, and poorer functional status. The findings support careful patient selection and procedural optimization to maximize MR reduction after TEER.