Transcatheter Repair in Posterior, Anterior, and Bileaflet Mitral Valve Disease

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BACKGROUND: Treating anterior and bileaflet mitral valve disease in patients with primary or degenerative mitral regurgitation (DMR) is considered more challenging than posterior leaflet repair. OBJECTIVES: The aim of this analysis was to evaluate the impact of anterior, posterior, or bileaflet disease on outcomes following mitral transcatheter edge-to-edge repair (M-TEER) in the EXPANDed studies. METHODS: EXPANDed is a pooled, patient-level analysis of subjects undergoing M-TEER with the MitraClip G3 or G4 system as part of the contemporary EXPAND and EXPAND G4 studies. Subjects with DMR were categorized according to echocardiography core laboratory-assessed prolapse or flail location into posterior (prolapse or flail at P1, P2, and/or P3), anterior (prolapse or flail at A1, A2, and/or A3) or bileaflet disease (prolapse or flail at any combination of A1, A2, and A3 and P1, P2, and P3). Key outcomes assessed included procedural outcomes, 30-day major adverse events, and 1-year mitral regurgitation (MR) severity. RESULTS: Of 2,205 subjects in EXPANDed, 556 had echocardiography core laboratory-assessed DMR and prolapse or flail location. A total of 389 had posterior, 106 had anterior, and 61 had bileaflet disease. All groups experienced low device and procedure times with high procedural success rates (defined as discharge MR ≤2+). Thirty-day major adverse events rates were low across all groups (posterior, 4.4% [17 of 388]; anterior, 3.8% [4 of 105]; bileaflet, 6.6% [4 of 61]; P = 0.65). Through 1 year, all groups showed a significant reduction in MR severity from baseline (MR ≤1+ posterior, 82% [179 of 219]; anterior, 93% [53 of 57]; bileaflet, 97% [28 of 29]). CONCLUSIONS: Results from the EXPANDed studies demonstrate that subjects with DMR treated with M-TEER experienced significant improvements in outcomes, regardless of the location of prolapse or flail.

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