PATIENTS with moderate or severe atrial functional mitral regurgitation (AFMR) who underwent transcatheter edge-to-edge repair (TEER) experienced fewer deaths and heart failure hospitalisations compared with those managed with medication alone, according to a large registry-based analysis.
AFMR, which is more common in elderly and frail individuals, occurs when the mitral valve leaks due to changes in the heart’s atrial structure, often linked to atrial fibrillation. While TEER is already used for certain types of mitral regurgitation, its prognostic benefit in AFMR has been unclear, particularly compared with standard medical therapy.
Researchers analysed 1,081 patients with moderate or severe AFMR, with 441 receiving TEER and 640 on medical therapy, drawing from the OCEAN-Mitral and REVEAL-AFMR registries. After balancing the two groups for baseline characteristics using propensity score methods, TEER was associated with significantly lower rates of the combined endpoint of all-cause death and heart failure hospitalisation (hazard ratio 0.65, 95% CI 0.43 to 0.99, p = 0.044) and lower all-cause mortality alone (HR 0.58, 95% CI 0.35 to 0.99, p = 0.044). Subgroup analysis suggested the best outcomes occurred in patients with mild or no residual AFMR post-procedure, whereas those with persistent moderate or greater leakage fared similarly to the medication group. Results were consistent in multiple sensitivity analyses, reinforcing the association between TEER and improved prognosis.
These findings indicate that TEER may offer meaningful survival and quality-of-life benefits for selected AFMR patients, particularly when procedural success leaves only minimal residual leakage. Further prospective studies could clarify patient selection criteria, refine procedural techniques, and confirm long-term safety. In practice, integrating TEER into treatment strategies for AFMR could expand management options for a group that often has limited therapeutic alternatives.
Reference
Kaneko T et al. Transcatheter edge-to-edge repair vs medical therapy in atrial functional mitral regurgitation: a propensity score-based comparison from the OCEAN-Mitral and REVEAL-AFMR registries. European Heart Journal. 2025;ehaf511.
