TCT-1120 Percutaneous MitraClip Versus Surgical Mitral Valve Repair or Replacement for Severe Functional Mitral Regurgitation: A Comparative Analysis of Long-Term Clinical Outcomes

Document Type

Abstract

Publication Date

10-28-2025

Abstract

Background: Functional mitral regurgitation (FMR) results from left ventricular dilation or dysfunction, rather than primary mitral valve pathology. Surgical mitral valve repair or replacement (sMVR) has been the traditional treatment for severe FMR, particularly in patients undergoing concomitant cardiac surgery. However, many patients with FMR are poor surgical candidates due to advanced age or comorbidities. MitraClip, a transcatheter edge-to-edge repair (TEER) device, has emerged as a less invasive alternative. This study compares long-term outcomes of MitraClip versus sMVR in patients with isolated severe FMR. Methods: A multicenter retrospective cohort study was conducted, analyzing data from 1,368 patients with isolated severe FMR (n=678 MitraClip, n=690 sMVR). Patients were propensity score matched for age, left ventricular ejection fraction (LVEF), NYHA class, and comorbidity index. The primary endpoints were all-cause mortality and heart failure (HF) rehospitalization at 3 years. Secondary outcomes included NYHA class improvement, procedural complications, and residual MR ≥ moderate. Kaplan-Meier survival analysis and Cox proportional hazard models were used. P-values < 0.05 were considered significant. Results: At 3-year follow-up, all-cause mortality was significantly lower in the MitraClip group compared to the surgical group (25.5% vs. 32.7%, p=0.01). Heart failure rehospitalization occurred less frequently in MitraClip patients (28.4% vs. 36.9%, p=0.007). MitraClip patients also experienced greater functional improvement, with more achieving NYHA class I/II (58.7% vs. 49.1%, p=0.02). However, residual MR ≥ moderate was more common in the MitraClip group (22.5% vs. 8.1%, p< 0.001). Procedural complications, including stroke, bleeding, and arrhythmia, were significantly higher in the surgical group. Conclusion: For patients with severe functional MR, especially those at elevated surgical risk, percutaneous MitraClip therapy provides a favorable balance of safety and clinical benefit, with lower mortality and hospitalization rates over 3 years. Surgical MVR remains appropriate for select lower-risk patients requiring more complete valve correction. Categories: STRUCTURAL: Valvular Disease and Intervention: Mitral

Publication Title

Journal of the American College of Cardiology

Volume

86

Issue

17 Supplement

First Page

B478

Last Page

B479

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