Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Dec 2;10(2):100772.
doi: 10.1016/j.shj.2025.100772. eCollection 2026 Feb.

Outcomes of Mitral Transcatheter Edge-to-Edge Repair in Patients With Small Mitral Valve Area

Chloe Kharsa  1 , Yasser M Sammour  1 , Rasha Bazari  1 , Alba Muñoz Estrella  1 , Gal Sella  1 , Sahar Samimi  1 , Samarthkumar Thakkar  1 , Mangesh Kritya  1 , Taha Hatab  1 , Rody G Bou Chaaya  1 , Syed Zaid  2 , Joe Aoun  1 , Sherif F Nagueh  1 , William A Zoghbi  1 , Marvin D Atkins  1 , Michael Reardon  1 , Nadeen N Faza  1 , Stephen H Little  1 , Gerald Lawrie  1 , Neal S Kleiman  1 , Sachin S Goel  1
Affiliations

Outcomes of Mitral Transcatheter Edge-to-Edge Repair in Patients With Small Mitral Valve Area

Chloe Kharsa et al. Struct Heart. .

Abstract

Background: A small baseline mitral valve area (MVA) raises concern for iatrogenic mitral stenosis due to increased transmitral pressure gradients (TMPG) after mitral transcatheter edge-to-edge repair (M-TEER). Outcomes in patients with MVA <4.0 cm² remain limited, as this population has been largely excluded from clinical trials.

Methods: We retrospectively analyzed 305 consecutive patients who underwent M-TEER (2014-2022). Patients were stratified by baseline MVA (<4.0 cm2 vs. ≥4.0 cm2). The primary endpoint was 2-year all-cause mortality. Secondary endpoints included heart failure hospitalization (HFH), mitral regurgitation (MR) reduction, New York Heart Association functional class improvement, and postprocedural TMPG.

Results: Of 305 patients, 66 (21.6%) had MVA <4.0 cm². Women were more prevalent in the small MVA group (57.6% vs. 42.7%; p = 0.03). Patients with smaller MVA received fewer clips (1.3 ± 0.07 vs. 1.5 ± 0.04; p = 0.03). Procedural success and in-hospital outcomes were comparable. At discharge, residual MR (<moderate) and New York Heart Association class were similar, although TMPG was higher in the small group (3.9 ± 0.2 vs. 3.3 ± 0.1 mmHg; p = 0.006). At 30 days and 1 year, mortality, HFH, and residual MR rates remained similar. Two-year Kaplan-Meier analyses showed no differences in survival, HFH, or composite outcomes. In multivariable analysis, age, creatinine, and hemoglobin predicted mortality, while age, LVEF, and hemoglobin predicted the composite outcome. Indexed MVA did not predict mortality or elevated TMPG.

Conclusions: M-TEER can be safely and effectively performed in patients with baseline MVA <4.0 cm2 without adverse clinical outcomes through 2 years.

Keywords: MitraClip; Mitral regurgitation; Mitral transcatheter edge-to-edge repair; Mitral valve area; Percutaneous mitral valve repair.

PubMed Disclaimer

Conflict of interest statement

M.D. Atkins is a consultant for W. L. Gore & Associates. M. Reardon is a consultant for Medtronic, Boston Scientific, Abbott, and W. L. Gore & Associates. N.S. Kleiman is a local principal investigator in trials sponsored by Boston Scientific, Medtronic, Abbott, and Edwards Lifesciences. S.S. Goel is a consultant for Medtronic, W. L. Gore & Associates, and JC Medical and is on the Speakers Bureau for Abbott Structural Heart. The other authors had no conflicts to declare.

Figures

Figure 1
Figure 1
Patient inclusion chart. Abbreviations: M-TEER, mitral transcatheter edge-to-edge repair; MVA, mitral valve area.
Figure 2
Figure 2
Changes in MR severity. Abbreviations: MR, mitral regurgitation; MVA, mitral valve area.
Figure 3
Figure 3
Changes in NYHA severity. Abbreviations: MVA, mitral valve area; NYHA, New York Heart Association.
Figure 4
Figure 4
Kaplan-Meier curve survival estimates for (a) all-cause mortality, (b) heart failure hospitalization, and (c) composite, stratified by mitral valve area group. Abbreviations: HFH, heart failure hospitalization; HR, hazard ratio; MVA, mitral valve area.
Figure 5
Figure 5
Forest plot for all-cause mortality predictors at follow-up following M-TEER. Abbreviations: HR, hazard ratio; M-TEER, mitral transcatheter edge-to-edge repair; TR, tricuspid regurgitation.
Figure 6
Figure 6
Forest plot for all-cause mortality +and heart failure hospitalization predictors at follow-up following M-TEER. Abbreviations: Hb, hemoglobin; HFH, heart failure hospitalization; HR, hazard ratio; LVEF, left ventricular ejection fraction; M-TEER, mitral transcatheter edge-to-edge repair; NYHA, New York Heart Association; TR, tricuspid regurgitation.
Figure 7
Figure 7
Kaplan-Meier survival estimates by mitral valve area (MVA <3.5 ​cm2 vs. 3.5<MVA<4.0 ​cm2). Abbreviation: HR, hazard ratio; MVA, mitral valve area.
Figure 8
Figure 8
ROC curve: predictive value of indexed mitral valve area (MVA) for (a) mortality and (b) TMPG >5 ​mm Hg ​at discharge. Abbreviations: MVA, mitral valve area; ROC, receiver-operating characteristic; TMPG, transmitral pressure gradient.
Supplement 1
Supplement 1
Kaplan-Meier Curve Survival Estimates in MVA<4cm2 stratified by MAC
Supplement 2
Supplement 2
Kaplan-Meier Curve Survival Estimates in (a) Female patients stratified by MVA and (b) in MVA<4.0 cm2 stratified by Gender
See this image and copyright information in PMC

Comment in

References

    1. Writing Committee Members, Otto C.M., Nishimura R.A., et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol. 2021;77(4):e25–e197. doi: 10.1016/j.jacc.2020.11.018. - DOI - PubMed
    1. Feldman T., Foster E., Glower D.D., et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med. 2011;364(15):1395–1406. doi: 10.1056/NEJMoa1009355. - DOI - PubMed
    1. Feldman T., Kar S., Rinaldi M., et al. Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol. 2009;54(8):686–694. doi: 10.1016/j.jacc.2009.03.077. - DOI - PubMed
    1. Altiok E., Hamada S., Brehmer K., et al. Analysis of procedural effects of percutaneous edge-to-edge mitral valve repair by 2D and 3D echocardiography. Circ Cardiovasc Imaging. 2012;5(6):748–755. doi: 10.1161/CIRCIMAGING.112.974691. - DOI - PubMed
    1. Noack T., Kiefer P., Mallon L., et al. Changes in dynamic mitral valve geometry during percutaneous edge-edge mitral valve repair with the MitraClip system. J Echocardiogr. 2019;17(2):84–94. doi: 10.1007/s12574-018-0398-0. - DOI - PubMed

LinkOut - more resources