TEER safe and feasible for patients with atrial secondary mitral regurgitation

Transcatheter edge-to-edge repair (TEER) is a safe and feasible treatment option for patients presenting with atrial secondary mitral regurgitation (ASMR), according to new research published in JACC: Cardiovascular Interventions.[1]

ASRM, the study’s authors explained, is a subtype of secondary mitral regurgitation (SMR) believed to be caused by left atrial (LA) enlargement and subsequent mitral annulus dilation. It is typically seen in patients with normal left ventricle size and function. TEER is the structural heart procedure that was commonly known as transcatheter mitral valve repair until 2021.

“TEER is an emerging treatment option for symptomatic SMR,” wrote Tetsu Tanaka, MD, a specialist with University Hospital Bonn in Germany, and colleagues. “The procedural result of TEER depends on the underlying mitral valve anatomy. According to previous reports, ASMR is typically characterized as SMR with enlarged LA and mitral annulus and flattened leaflets. These anatomical features are different from ventricular SMR (VSMR) and might therefore impact the procedural results of TEER.”

Tanaka et al. examined data from 415 patients with SMR who underwent TEER at the same facility from September 2010 to September 2021. All patients were treated with the MitraClip device developed by Abbott. The mean patient age was 80 years old, and any patient with a prior history of surgical or transcatheter mitral valve interventions was excluded from the analysis.

Overall, 28.4% of patients with SMR met the criteria for ASMR. The procedure’s technical success rate was 94.1% among those patients, and mitral regurgitation (MR) was reduced to ≤1+ after TEER in 79.7%, a comparable rate to what was seen among patients with VSMR. The in-hospital mortality rate was 2.5%.

Reviewing the echocardiography results of each patient, Tanaka and colleagues found that a smaller LA volume index and higher leaflet-to-annulus index were associated with a greater chance of MR being reduced to ≤1+ after TEER.

“Risk stratification based on these echocardiographic parameters could assist with the patient selection for TEER and refine the procedural results of TEER in patients with ASMR.” the authors wrote.

The group also noted that four different generations of the MitraClip device were used over the course of the study: MitraClip, MitraClip NT, MitraClip NTR/XTR and MitraClip G4. The MitraClip NTR/XTR and MitraClip G4 devices were linked to improved MR reduction compared to the older-generation MitraClip and MitraClip NT devices.

“A further investigation is needed to assess that the MR reduction by TEER can improve clinical outcomes in patients with ASMR,” the authors concluded.

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