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Observational Study
. 2025 Aug 25;18(16):2020-2032.
doi: 10.1016/j.jcin.2025.05.031. Epub 2025 Jun 25.

Transcatheter Edge-to-Edge Repair for Atrial and Ventricular Secondary Mitral Regurgitation: Insights From the REPAIR Study

Philipp von Stein  1 , Lukas Stolz  2 , Jean Marc Haurand  3 , Matthias Gröger  4 , Felix Rudolph  5 , Donika Mustafa  6 , Jannik Jobst  7 , Christoph Alexander Mues  8 , Amir Abbas Mahabadi  9 , Isabel A Hoerbrand  10 , Carl Schulz  11 , Atsushi Sugiura  12 , Jennifer von Stein  13 , Christos Iliadis  6 , Philipp Lurz  14 , Muhammed Gerçek  5 , Patrick Horn  3 , Mirjam Kessler  4 , Guido Ascione  15 , Tienush Rassaf  9 , Marcel Weber  12 , Niklas Schofer  11 , Mathias Konstandin  10 , Florian Schindhelm  9 , Helge Möllmann  8 , Bernhard Unsöld  7 , Henning Guthoff  6 , Stephan Baldus  6 , Wolfgang Rottbauer  4 , Volker Rudolph  5 , Juan F Granada  15 , Jörg Hausleiter  2 , Roman Pfister  6 , Victor Mauri  16 ; REPAIR Investigators
Collaborators, Affiliations
Free article
Observational Study

Transcatheter Edge-to-Edge Repair for Atrial and Ventricular Secondary Mitral Regurgitation: Insights From the REPAIR Study

Philipp von Stein et al. JACC Cardiovasc Interv. .
Free article

Abstract

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.

Keywords: M-TEER; PASCAL; REPAIR; mitral regurgitation; mitral valve transcatheter edge-to-edge repair; real-world.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Gerçek has received a research grant from the Ruhr-University Bochum as Advanced Clinician Scientist; and served as a consultant for Edwards Lifesciences. Dr Baldus and Dr Mauri were supported by the Deutsche Forschungsgemeinschaft, Bonn, Germany (397484323). Dr Stolz has received speaker honoraria from Edwards Lifesciences. Dr Mahabadi has received honoraria, lecture fees, and/or grant support from Amgen, Daiichi-Sankyo, Edwards Lifesciences, Novartis, Sanofi, all unrelated to this work; and is cofounder of Mycor GmbH, a company focusing on AI-based ECG algorithms. Dr von Stein has received speaker honoraria from Edwards Lifesciences. Dr Lurz has received institutional fees and research grants from Abbott Cardiovascular, Edwards Lifesciences, and Medtronic. Dr Horn has received an unrestricted research grant from Edwards Lifesciences; and has received speaking honoraria from Abbott Cardiovascular. Dr Rassaf has received honoraria, lecture fees, and grant support from Edwards Lifesciences, AstraZeneca, Bayer, Novartis, Berlin Chemie, Daiichi-Sankyo, Boehringer Ingelheim, Novo Nordisk, Cardiac Dimensions, and Pfizer, all unrelated to this work; and is cofounder of Bimyo GmbH, a company that develops cardioprotective peptides, cofounder of Mycor GmbH, a company focusing on AI-based EKG-algorithms, and cofounder of Yes2NO, developing nitric oxide-based treatments. Dr Schindhelm has received speaker honoraria and travel expenses from Edwards Lifesciences, MedMile, and Björn Steiger Stiftung. Dr Möllmann has received speaker honoraria from Abbott Cardiovascular and Edwards Lifesciences. Dr Baldus has received honorarium for consultation by Edwards Lifesciences. Dr Rudolph has received research grants and honoraria for consultation from Edwards Lifesciences. Dr Hausleiter has received speaker honoraria from and serves as a consultant for Edwards Lifesciences. Dr Pfister has received an honorarium for consultation by Edwards Lifesciences. Dr Mauri has received speaker honoraria and travel compensation by Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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