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One-year Outcomes Stratified by Gradient and Residual Mitral Regurgitation (MR) after Transcatheter Edge-to-Edge Repair in Degenerative MR: Results from the CLASP IID Trial

https://doi.org/10.1007/s00392-025-02625-4

Jörg Hausleiter (München)1, A. Narang (IL)2, D. S. Lim (VA)3, R. L. Smith (TX)4, F. Zahr (OR)5, S. Chadderdon (OR)5, J. Puthumana (IL)2, R. Makkar (CA)6, M. M. Makar (CA)6, R. S. von Bardeleben (Mainz)7, T. Ruf (Mainz)8, T. Gößler (Mainz)8, R. M. Kipperman (NJ)9, A. N. Rassi (CA)10, I. A. Ku (CA)10, M. Näbauer (München)1, M. Szerlip (TX)4, Z. Wang (TX)4, S. Goldman (PA)11, K. M. Hawthorne (PA)11, K. Koulogiannis (NJ)9, L. Marcoff (NJ)9, L. D. Gillam (NJ)9, C. J. Davidson (IL)2

1LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland; 2Bluhm Cardiovascular Institute, Northwestern University IL, USA; 3University of Virginia Health System Hospital VA, USA; 4Baylor Scott and White: The Heart Hospital TX, USA; 5Oregon Health & Science University OR, USA; 6Cedars-Sinai Medical Center CA, USA; 7Universitätsmedizin der Johannes Gutenberg-Universität Mainz Zentrum für Kardiologie im Herz- und Gefäßzentrum Mainz, Deutschland; 8Universitätsmedizin der Johannes Gutenberg-Universität Mainz Kardiologie 1, Zentrum für Kardiologie Mainz, Deutschland; 9Atlantic Health System Morristown Medical Center NJ, USA; 10Kaiser Permanente San Francisco Medical Center CA, USA; 11Lankenau Medical Center PA, USA

 

Background: Optimal reduction of mitral regurgitation (MR) in mitral transcatheter edge-to-edge repair (M-TEER) improves patient outcomes and is balanced against elevated transmitral gradients (TMG). Understanding the implications of MR optimization and TMG informs procedural strategies.

Methods: One-year outcomes from the randomized CLASP IID trial (NCT03706833) were analyzed by discharge TMG ≤5 vs. >5 mmHg and discharge MR ≤1+ vs. ≥2+ in prohibitive surgical risk patients with 3+/ 4+ degenerative MR (DMR).

Results: The analysis included 284 patients divided into 4 groups, TMG ≤5 and MR ≤1+: 72.5% patients (n=206), TMG >5 and MR ≤1+: 11.6% (n=33), TMG ≤5 and MR ≥2+: 11.3% (n=32), and TMG >5 and MR ≥2+: 4.6% (n=13). Baseline characteristics were similar between groups. At 1 year, the composite rate of survival, and freedom from heart failure hospitalization or non-elective mitral valve reintervention was significantly different (P=0.011, Fig). All groups had significant reduction in LV diastolic and systolic volumes (all P<0.05 vs. baseline, and baseline adjusted inter-group P=0.193 and 0.751, respectively), and a high proportion were New York Heart Association Class I/II (range: 80.0 to 90.0%, all P<0.05 vs. baseline, inter-group P=0.443).

Conclusions: In DMR patients treated with M-TEER in the CLASP IID trial, achieving discharge MR ≤1+ was more impactful in improving clinical outcomes than maintaining gradients ≤5 mmHg, suggesting a benefit of optimizing MR over preserving lower gradients.



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