Combined impact of residual mitral regurgitation and iatrogenic mitral stenosis on outcomes after mitral transcatheter edge-to-edge repair with the mitraclip device

Transcatheter mitral valve repair (M-TEER) is a key alternative for symptomatic patients at high surgical risk. However, this technique may induce iatrogenic mitral stenosis. The pronostic impact of stenosis assessed by 3D planimetry, in correlation with residual mitral regurgitation, remains unclear. To evaluate the prognostic impact of mitral stenosis assessed by 3D planimetry in relation to residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral valve repair (M-TEER). This retrospective monocentric study included 249 patients who underwent M-TEER between 2016 and 2024. Patients were stratified according to residual MR severity (≥ or < grade 2) and mitral valve area (MVA, < or ≥1.5 cm 2 ). The primary endpoint was a composite of cardiovascular death, heart failure hospitalization, or mitral valve reintervention at 1 year. The primary endpoint occurred in 16% of patients. Residual MR ≥2 was significantly associated with worse outcomes ( P = 0.01), while MVA <1.5 cm 2 was not ( P = 0.71). Patients with MR <2 and MVA ≥1.5 cm 2 had the best prognosis (10% events) ( Figure 1 ). A higher number of clips and mean gradients were observed in the stenosis group. 3D MVA measurement showed good reproducibility but poor correlation with mean gradient. In this cohort, residual MR, but not stenosis assessed by 3D planimetry, was predictive of adverse outcomes at 1 year. Achieving minimal MR appears more prognostically relevant, even at the cost of moderate stenosis.