Background:
Transcatheter edge-to-edge repair has become an established treatment option of severe mitral valve regurgitation for anatomically suitable pathologies and has been subsequently emphasized in current european guidelines (Eur Heart J, 2025). In most qualified centers, mitral valve transcatheter edge-to-edge repair (M-TEER) is performed under general anesthesia, therefore requiring specialized pre- and periprocedural anesthesiologic care, an establishment of invasive hemodynamic monitoring including central venous access as well as postprocedural intensive care surveillance. Conscious sedation emerged as a promising alternative to general anesthesia, since the former yields a lower procedural risk and lighter economic burden. Although the feasibility of performing M-TEER under conscious sedation has been shown, data about direct comparisons and clinical follow-up are very limited.
Here, we are able to provide a direct comparison of patients undergoing M-TEER under both conditions in the same center and team of operators.
Methods and Results:
We retrospectively screened patients undergoing M-TEER between 01/2023 and 01/2026 in a tertiary care center in Homburg/Saar, Germany. After excluding 5 patients due to cardiogenic shock, we analyzed 106 patients, of whom 58 underwent concious sedation. The baseline characteristics showed no clinically meaningful differences in age, sex, NYHA class, etiology, EuroScore II, left ventricular diameter and function as well as relevant comorbidities. There were no significant differences in peri- and postprocedural adverse events. Patients under conscious sedation displayed shorter procedure durations (54 vs. 80 minutes; p<0.05) and faster dicharge (2.3 vs. 4.3 days; p<0.05) compared to general anesthesia. After 30 days, both cohorts displayed similar residual mitral regurgitation (less than grade 2 in 87 % vs. 83 % of patients). Respectively, at a mean follow-up of 300 days, both groups showed no significant difference in hospitalizations for heart failure (29 % vs. 31 %; p=0.7).
Conclusions:
Conscious sedation in patients receiving transcatheter mitral valve repair is safe, feasible and associated with comparable clinical and echocardiografical outcomes compared to general anesthesia.
