Durability of Mitral Valve Transcatheter Edge-to-Edge Repair: An Expert Overview

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: MR recurrence: 5-10% early, 17% at 5 years; Reintervention: 5-10% early, 9% at 5 years

• Primary Outcome: MR recurrence and reintervention rates over time

• Nnt Or Sensitivity: 41% of primary MR patients experienced MR recurrence or reintervention at 5 years

• Confidence Interval: 95% CIs calculated but specific values not provided in abstract

Clinical Application

M-TEER widely available in tertiary centres; redo procedures appear safer than surgery but with higher recurrence rates Relevant to Australian cardiothoracic centres offering M-TEER; aligns with current TGA-approved devices and emerging PBS considerations for transcatheter valve interventions Patients with moderate-to-severe mitral regurgitation being considered for M-TEER, particularly those with primary MR who may have higher failure rates

Abstract

BACKGROUND: Mitral regurgitation (MR) is a globally endemic heart disease burden with significant morbidity and mortality. Mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a minimally invasive treatment with established safety and intermediate-term efficacy. OBJECTIVES: The aim of this study was to determine M-TEER durability and the incidence, risk factors, and treatment strategies of M-TEER failure. METHODS: A comprehensive literature review was performed, identifying 457 records, from which 33 full-text papers were included. Definitions of MR recurrence, reintervention, and M-TEER durability and failure were provided. On the basis of these definitions, weighted means with 95% CIs were calculated for the rates of MR recurrence, reintervention, and their composite for both the overall population and the primary and secondary MR subgroups. RESULTS: The pooled weighted means of MR recurrence and reintervention ranged between 5% and 10% in the first months after the index procedure, remained relatively stable for the first 3 years, and increased at 5 years to 17% and 9%, respectively. MR recurrence and reintervention weighted means were numerically higher in primary than secondary MR, and 41% of primary MR patients experienced MR recurrence or reintervention at 5 years. Redo transcatheter edge-to-edge repair for M-TEER failure seemed safer than surgery but was associated with 1-year MR recurrence rates between 20% and 40%. Mitral valve replacement was the most common surgical technique for M-TEER failure. CONCLUSIONS: The incidence of M-TEER failure after a successful index procedure increases after 3 years and is more pronounced with primary than secondary MR. More systematic, longer term follow-up data after M-TEER are required to better define M-TEER durability.

References

1. 1.Mariani, A., Stolz, L., von Bardeleben, R. S., Treede, H., Modine, T., Kardys, I., Latib, A., Lim, D. S., Hausleiter, J., & Van Mieghem, N. M. (2026). Durability of mitral valve transcatheter edge-to-edge repair: An expert overview. JACC: Cardiovascular Interventions. https://doi.org/10.1016/j.jcin.2026.02.019