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Transcatheter edge-to-edge repair for atrial and ventricular secondary mitral regurgitation: insights from the REPAIR study

Background - Secondary mitral regurgitation (SMR) has 2 phenotypes: atrial (aSMR) and ventricular (vSMR). The role of mitral valve transcatheter edge-to-edge repair (M-TEER) in aSMR remains less defined, with limited evidence on the PASCAL implant (Edwards Lifesciences). - Objectives - The authors s...

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Main Authors: Stein, Philipp von (Author) , Stolz, Lukas (Author) , Haurand, Jean (Author) , Gröger, Matthias (Author) , Rudolph, Felix (Author) , Mustafa, Donika (Author) , Jobst, Jannik (Author) , Mues, Christoph Alexander (Author) , Mahabadi, Amir Abbas (Author) , Hörbrand, Isabel (Author) , Schulz, Carl (Author) , Sugiura, Atsushi (Author) , Stein, Jennifer von (Author) , Iliadis, Christos (Author) , Lurz, Philipp (Author) , Gerçek, Muhammed (Author) , Horn, Patrick (Author) , Keßler, Mirjam (Author) , Ascione, Guido (Author) , Rassaf, Tienush (Author) , Weber, Marcel (Author) , Schofer, Niklas (Author) , Konstandin, Mathias (Author) , Schindhelm, Florian (Author) , Möllmann, Helge (Author) , Unsöld, Bernhard (Author) , Guthoff, Henning (Author) , Baldus, Stephan (Author) , Rottbauer, Wolfgang (Author) , Rudolph, Volker (Author) , Granada, Juan F. (Author) , Hausleiter, Jörg (Author) , Pfister, Roman (Author) , Mauri, Victor (Author) , Bardeleben, Ralph Stephan von (Author) , Ennin, Cecilia (Author) , Friedrichs, Kai Peter (Author) , Grothusen, Christina (Author) , Kelm, Malte (Author) , Kister, Tobias (Author) , Nickenig, Georg (Author) , Piayda, Kerstin (Author) , Ruf, Tobias (Author) , Sagmeister, Paula (Author) , Schneider, Leonhard Moritz (Author) , Thiele, Holger (Author) , Widmann, Laila (Author)
Format: Article (Journal)
Language:English
Published: 25 August 2025
In: JACC Cardiovascular interventions
Year: 2025, Volume: 18, Issue: 16, Pages: 2020-2032
ISSN:1876-7605
DOI:10.1016/j.jcin.2025.05.031
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.jcin.2025.05.031
Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S1936879825016152
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Author Notes:Philipp von Stein, Lukas Stolz, Jean Marc Haurand, Matthias Gröger, Felix Rudolph, Donika Mustafa, Jannik Jobst, Christoph Alexander Mues, Amir Abbas Mahabadi, Isabel A. Hoerbrand, Carl Schulz, Atsushi Sugiura, Jennifer von Stein, Christos Iliadis, Philipp Lurz, Muhammed Gerçek, Patrick Horn, Mirjam Kessler, Guido Ascione, Tienush Rassaf, Marcel Weber, Niklas Schofer, Mathias Konstandin, Florian Schindhelm, Helge Möllmann, Bernhard Unsöld, Henning Guthoff, Stephan Baldus, Wolfgang Rottbauer, Volker Rudolph, Juan F. Granada, Jörg Hausleiter, Roman Pfister, Victor Mauri, Ralph-Stephan von Bardeleben, Cecilia Ennin, Kai Peter Friedrichs, Christina Grothusen, Malte Kelm, Tobias Kister, Georg Nickenig, Kerstin Piayda, Tobias Ruf, Paula Sagmeister, Leonhard Moritz Schneider, Holger Thiele, Laila Widmann
Description
Summary:Background - Secondary mitral regurgitation (SMR) has 2 phenotypes: atrial (aSMR) and ventricular (vSMR). The role of mitral valve transcatheter edge-to-edge repair (M-TEER) in aSMR remains less defined, with limited evidence on the PASCAL implant (Edwards Lifesciences). - Objectives - The authors sought to evaluate and compare outcomes of SMR phenotypes undergoing M-TEER. - Methods - REPAIR (REgistry of PAscal for mItral Regurgitation) is an investigator-initiated, multicenter registry of patients undergoing M-TEER. aSMR was defined by left atrial dilation with preserved left ventricular size and ejection fraction. Outcomes included MR ≤1+ at discharge, technical success, NYHA functional class improvement, and 1-year survival. - Results - Among 915 patients (166 [18%] aSMR, 749 [82%] vSMR), the median follow-up was 491 days (Q1-Q3: 360-833 days). MR ≤1+ was achieved in 77.2% vs 71.4% (P = 0.162), with technical success in 97.0% vs 98.3% (P = 0.446). NYHA functional class improved in both phenotypes (P < 0.001), with 61.2% vs 61.3% in functional class ≤II at follow-up (P > 0.999). One-year survival was 88.4% (95% CI: 82.8%-94.4%) vs 86.0% (95% CI: 83.1%-89.0%; P = 0.346). In aSMR patients, 1-year survival was significantly lower in patients with baseline tricuspid regurgitation (TR) grade ≥moderate compared with those with <moderate TR (84.3% [95% CI: 77.0%-92.3%] vs 100.0% [95% CI: 100.0%-100.0%]; P = 0.041). In vSMR patients, survival was similar between ≥moderate and <moderate baseline TR (83.9% [95% CI: 79.8%-88.2%] vs 89.3% [95% CI: 85.0%-93.8%]; P = 0.051). - Conclusions - M-TEER effectively reduces MR to ≤1+ and improves symptoms in both aSMR and vSMR. Particularly in aSMR, ≥moderate baseline TR is linked to worse outcomes, warranting consideration as an additional treatment target.
Item Description:Gesehen am 05.03.2026
Physical Description:Online Resource
ISSN:1876-7605
DOI:10.1016/j.jcin.2025.05.031

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