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Comparative Study
. 2025 Apr 14;18(7):898-908.
doi: 10.1016/j.jcin.2024.12.023. Epub 2025 Mar 5.

Transcatheter Repair in Posterior, Anterior, and Bileaflet Mitral Valve Disease: 1-Year Results From EXPANDed

Saibal Kar  1 , Matthew J Price  2 , M Andrew Morse  3 , Michael J Rinaldi  4 , Paul Mahoney  5 , Paolo Denti  6 , Federico M Asch  7 , Jose L Zamorano  8 , Janani Aiyer  9 , Rong Huang  9 , Francesco Maisano  6 , Ralph Stephan von Bardeleben  10 , Evelio Rodriguez  3
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Free article
Comparative Study

Transcatheter Repair in Posterior, Anterior, and Bileaflet Mitral Valve Disease: 1-Year Results From EXPANDed

Saibal Kar et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: Treating anterior and bileaflet mitral valve disease in patients with primary or degenerative mitral regurgitation (DMR) is considered more challenging than posterior leaflet repair.

Objectives: The aim of this analysis was to evaluate the impact of anterior, posterior, or bileaflet disease on outcomes following mitral transcatheter edge-to-edge repair (M-TEER) in the EXPANDed studies.

Methods: EXPANDed is a pooled, patient-level analysis of subjects undergoing M-TEER with the MitraClip G3 or G4 system as part of the contemporary EXPAND and EXPAND G4 studies. Subjects with DMR were categorized according to echocardiography core laboratory-assessed prolapse or flail location into posterior (prolapse or flail at P1, P2, and/or P3), anterior (prolapse or flail at A1, A2, and/or A3) or bileaflet disease (prolapse or flail at any combination of A1, A2, and A3 and P1, P2, and P3). Key outcomes assessed included procedural outcomes, 30-day major adverse events, and 1-year mitral regurgitation (MR) severity.

Results: Of 2,205 subjects in EXPANDed, 556 had echocardiography core laboratory-assessed DMR and prolapse or flail location. A total of 389 had posterior, 106 had anterior, and 61 had bileaflet disease. All groups experienced low device and procedure times with high procedural success rates (defined as discharge MR ≤2+). Thirty-day major adverse events rates were low across all groups (posterior, 4.4% [17 of 388]; anterior, 3.8% [4 of 105]; bileaflet, 6.6% [4 of 61]; P = 0.65). Through 1 year, all groups showed a significant reduction in MR severity from baseline (MR ≤1+ posterior, 82% [179 of 219]; anterior, 93% [53 of 57]; bileaflet, 97% [28 of 29]).

Conclusions: Results from the EXPANDed studies demonstrate that subjects with DMR treated with M-TEER experienced significant improvements in outcomes, regardless of the location of prolapse or flail.

Keywords: M-TEER; MitraClip; mitral regurgitation; mitral transcatheter edge-to-edge repair; mitral valve repair.

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Conflict of interest statement

Funding Support and Author Disclosures The EXPAND and EXPAND G4 studies are sponsored by Abbott Structural Heart. Dr Kar has received grants and institutional research support from Abbott, Boston Scientific, and Edwards Lifesciences; has received consulting fees and honoraria from Abbott, Boston Scientific, W.L. Gore & Associates, and Medtronic; has served as a steering committee member of the TRILUMINATE study (Abbott); and has served as national principal investigator of the EXPAND study and the REPAIR MR study for Abbott. Dr Price has received consulting fees and honoraria from Abbott, Boston Scientific, InnovHeart, Medtronic, Philips Medical, W.L. Gore & Associates, and Shockwave Medical. Dr Morse is a consultant for Edwards Lifesciences. Dr Rinaldi has received honoraria and/or consulting fees from Abbott, Boston Scientific, and Edwards Lifesciences. Dr Mahoney is a consultant and proctor for Medtronic, Edwards Lifesciences, and Boston Scientific; is a consultant for Abbott; and has received research grants from Edwards Lifesciences, Medtronic, Abbott, and Boston Scientific. Dr Denti has received speaker honoraria from Abbott and Edwards Lifesciences; and has been a consultant to InnovHeart, Artiness, and Pi-Cardia. Dr Asch’s work as director of an academic core laboratory is paid for by institutional research grants (MedStar Health) from Abbott, Boston Scientific, Medtronic, Edwards Lifesciences, Neovasc, Ancora Heart, LivaNova, MVRx, InnovHeart, Polares Medical, and Aria CV. Dr Zamorano has received speaker honoraria from Pfizer, Amgen, and Daiichi-Sankyo; and has received research grants from Abbott and Edwards Lifesciences. Ms Aiyer and Ms Huang are salaried employees of Abbott Structural Heart. Dr Maisano has received grant and/or institutional research support from Abbott, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific Corporation, NVT, and Terumo; has received consulting fees and personal and institutional honoraria from Abbott, Medtronic, Edwards Lifesciences, Xeltis, and Cardiovalve; has received royalty income from and holds intellectual property rights with Edwards Lifesciences; and is a shareholder (including share options) of CardioGard Medical, Magenta, SwissVortex, Transseptal Solutions, Occlufit, 4Tech, and Perifect. Dr von Bardeleben has served in unpaid trial activities for Abbott, Edwards Lifesciences, and the University of Göttingen (IIT); and has served on advisory boards or Speakers Bureaus for Abbott Cardiovascular, Cardiac Dimensions, Edwards Lifesciences, Jenscare, and NeoChord. Dr Rodriguez has been awarded grants and support for research from Abbott, Edwards Lifesciences, Boston Scientific, AtriCure, and CardioMech; and has received honoraria or consulting fees from Abbott, Edwards Lifesciences, Philips, Teleflex, and CardioMech.

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