Cardiovascular

Impact of Recurrent Mitral Regurgitation Following Mitral Transcatheter Edge-to-Edge Repair on Long-Term Outcomes.

Pauschinger C, Koell B, et al. • JACC. Cardiovascular interventions • 2026

PubMed 42933917 DOI 10.1016/j.jcin.2026.07.015
TL;DR

recMR is common and independently associated with increased mortality after M-TEER, with a more pronounced effect in patients with DMR.

Key Findings

Results

Recurrent mitral regurgitation (recMR) occurred in about one-third of patients after initially successful M-TEER.

  • The retrospective cohort included 461 consecutive patients with successful M-TEER (residual MR ≤2+ at discharge) between 2008 and 2021.
  • recMR was defined as ≥1-grade increase in MR severity at follow-up compared with discharge.
  • recMR occurred in 31.7% (146 of 461) of patients.
  • Median follow-up was 3.44 years (Q1-Q3: 1.51-3.99 years).
Results

The frequency of recMR was similar in functional and degenerative MR.

  • recMR occurred in 31.9% (104 of 326) of patients with FMR.
  • recMR occurred in 31.1% (42 of 135) of patients with DMR.
  • DMR accounted for 29.3% (135 of 461) of the cohort; mean age was 75.0 ± 9.1 years and 60.7% were male.
Results

In a 12-month landmark analysis, absence of recMR was associated with better survival.

  • The log-rank P value was 0.0088 favoring patients without recMR.
  • The primary endpoint was all-cause mortality.
Results

Four-year all-cause mortality was higher in patients with recMR than in those without.

  • Mortality was 44.8% (95% CI: 38.7%-50.3%) without recMR.
  • Mortality was 56.3% (95% CI: 47.2%-63.9%) with recMR.
Results

recMR was an independent predictor of higher mortality in multivariable Cox regression.

  • HR: 1.43; 95% CI: 1.06-1.93; P = 0.019.
Results

The survival difference associated with recMR was significant in DMR but not in FMR.

  • DMR: log-rank P = 0.014.
  • FMR: log-rank P = 0.11.
  • The authors conclude the effect is more pronounced in DMR.
Conclusions

Identifying patients at risk of recMR may inform closer surveillance and timely reintervention.

  • Residual MR after M-TEER is a known major determinant of outcome, but the prognostic impact of recMR after initially successful repair was previously unclear.
  • This study's findings suggest recMR is an important prognostic factor beyond discharge MR.

What This Means

This study looked at 461 patients who had a catheter-based mitral valve repair (mitral transcatheter edge-to-edge repair, or M-TEER) that initially worked well, meaning leakage through the valve was mild or less at discharge. The researchers asked what happens if the leakage later comes back or worsens, and whether this affects survival over the long term. About one in three patients (31.7%) had leakage that worsened by at least one grade during follow-up, with similar rates in those with functional and degenerative valve disease. After four years, about 56% of patients with recurrent leakage had died, compared with about 45% of those without recurrence. After accounting for other factors, recurrent leakage was independently linked to a 43% higher risk of death. The survival difference was statistically clear in patients with degenerative disease but not in those with functional disease. This research suggests that recurrent leakage after an initially successful repair is common and matters for long-term survival. It may support closer follow-up of patients after M-TEER and earlier consideration of further treatment. Because the study was retrospective, it shows an association and cannot prove that recurrent leakage itself causes the higher mortality.

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Citation

Pauschinger C, Koell B, Heinze A, Schirmer J, Girdauskas E, Waldschmidt L, et al.. (2026). Impact of Recurrent Mitral Regurgitation Following Mitral Transcatheter Edge-to-Edge Repair on Long-Term Outcomes.. JACC. Cardiovascular interventions. https://doi.org/10.1016/j.jcin.2026.07.015