TVT registry analysis finds close to 90% success in mitral TEER procedures

Raj Makkar

A large registry study of patients undergoing transcatheter edge-to-edge repair (TEER) for degenerative mitral regurgitation (MR) using the MitraClip (Abbott) system, has concluded that the procedure resulted in successful repair in almost 90% of patients.

Results of the study, authored by Raj Makkar (Cedars-Sinai, Los Angeles, USA), were published in the Journal of the American Medical Association (JAMA), and represent the largest study to date that examines outcomes for patients treated outside of a clinical trial with TEER, according to researchers..

“Treatment was successful in nearly nine out of every 10 patients in whom TEER was used to repair their mitral valve,” said Makkar. “These strong safety and efficacy outcomes were validated, despite the advanced age and significant comorbidities of these patients.”

Using data from the Transcatheter Valve Therapy (TVT) Registry—a jointly maintained database from the Society for Thoracic Surgery (STS) and the American College of Cardiology (ACC)—Makkar and his fellow investigators analysed 19,088 patients who underwent TEER for moderate to severe isolated degenerative MR between January 2014 and June 2022.

The study’s primary endpoint was mitral regurgitation success, defined by investigators as moderate or better residual mitral regurgitation without narrowing of the mitral valve. Additional endpoints included death while hospitalised and within 30 days and within one year of the procedure.

The study recorded that the patients’ average age was 82, and 49% were women. Mitral regurgitation success was shown in 88.9% of patients, while at 30 days, the incidence of death was 2.7%, stroke was 1.2% and mitral valve reintervention was 0.97%. The lowest mortality rate was observed in patients who had both mild or less residual mitral regurgitation.

“For patients at elevated risk for surgery, TEER with the MitraClip device is a meaningful treatment option,” said Makkar. “The procedure is getting many patients back to a more energetic life, and back to activities some haven’t been able to do for years.”

“Surgery is successful in nearly 100% of patients having degenerative mitral repair today in the USA, restoring normal life-expectancy in most patients,” said Joanna Chikwe (Cedars Sinai, Los Angeles, USA) a study author. “A heart team discussion is essential for patients deciding between surgery or interventional approaches, and we need randomized trials to inform these important decisions.”

Chikwe is principal investigator of the PRIMARY clinical trial—a multicentre, international trial—comparing the surgical approach for valve repair with the TEER procedure. The trial, funded by the National Institutes of Health, is expected to complete enrolment in January 2026.


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