TEER With MitraClip for Treatment of Atrial Secondary Mitral Regurgitation

Among patients with atrial secondary mitral regurgitation (aSMR), transcatheter edge-to-edge repair (TEER) is associated with significant mitral regurgitation (MR) reduction and improved quality of life. These findings were published in JACC: Cardiovascular Interventions.

A Contemporary, Prospective, Multi-Center Study Evaluating Real-World Experience of Performance and Safety for the Next Generation of MitraClip Devices (EXPAND; ClinicalTrials.gov Identifier: NCT03502811) study recruited 1041 patients from 57 sites in North America, Europe, and the Middle East between 2018 and 2019. All patients received TEER, as per center standard of care, with the MitraClip NTR/XTR system. The safety and effectiveness of TEER on secondary MR (N=413) was evaluated up to 1 year in this analysis. Atrial SMR was defined as left ventricular ejection fraction (LVEF) of 45% or more with no regional wall or mitral valve abnormalities.

Patients had aSMR (n=53) and ventricular secondary MR (vSMR; n=360). At baseline the patient groups included 39.6% and 61.1% men (P =.003), were aged mean 79.4±6.9 and 74.7±10.0 years (P <.0001), and had an LVEF of 60.06%±5.85% and 35.99%±11.23% (P <.001), respectively.

At 30-days and 1-year, MR severity was significantly reduced among both the aSMR and vSMR cohorts (all P £.001). By year 1, 100% of the aSMR group and 99.5% of the vSMR group had MR of 2+ or less. Similarly, both New York Heart Association Functional Class and Kansas City Cardiomyopathy Questionnaire scores improved significantly from baseline among both groups (all P ≤.001).

At year 1, the aSMR group was associated with a numerically lower rate of heart failure hospitalizations (18.1% vs 27.2%; P =.16) and mortality (14.1% vs 18.2%; P =.41) compared with vSMR, respectively.

Adverse event rates were similar between the 2 cohorts. Major adverse events occurred among 3.8% and 3.6% (P =.99), nonelective cardiovascular surgery for device-related complications occurred among 0.0% and 1.1% (P =.99), and leaflet adverse events of single-leaflet device attachment among 1.9% and 1.9% (P =.99) and leaflet injury among 0.0% and 0.6% of the aSMR and vSMR cohorts (P =.99), respectively.

The findings of this study may not be generalizable, as the definition of aSMR varies substantial in the literature.

“[…] TEER for aSMR was associated with significant MR reduction and improvement in quality of life and functional class, similar to patients with vSMR,” the study authors wrote. “This suggests that TEER may provide clinical benefit in patients with atrial fibrillation with SMR in the setting of heart failure with preserved ejection fraction.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Sodhi N, Asch FM, Ruf T, et al. Clinical outcomes with transcatheter edge-to-edge repair in atrial functional MR from the EXPAND study. JACC Cardiovasc Interv. Published online September 5, 2022. doi:10.1016/j.jcin.2022.07.023