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  • Intraprocedural Residual MR Predicts 1-Year Mortality after Mitral TEER – MITRA-PRO Registry

    Among all comers receiving mitral transcatheter edge-to-edge repair (TEER), intraprocedural residual mitral regurgitation (MR) with MitraScore ≥4 was associated with increased rate of mortality at 1 year, a multicenter registry study shows.

    This suggests that the MitraScore improves MR assessment and, therefore, might help clinicians optimize treatment to increase patient survival.

    Peter Boekstegers, MD, of Helios Klinikum Siegburg in Siegburg, Germany, and colleagues presented these findings in a manuscript published Monday online and in the March 13 issue of JACC: Cardiovascular Interventions.

    Mitral TEER has been shown to reduced mortality and heart failure hospitalization among patients with degenerative and functional MR. However, TEER may have varying degrees of success, and the effect of residual MR on clinical outcomes after TEER is unknown.

    Boekstegers and colleagues utilized data from the prospective, multicenter MITRA-PRO registry (A Prospective Registry Study on 1-Year Mortality and the Prognostic Significance of MitraScore After MitraClip Implantation in Patients with Mitral Regurgitation) to study the effect of residual MR on clinical outcomes at 1 year. Patients were divided according MitraScore (≤ 3 vs. ≥ 4), a multimodality metric including echocardiography, hemodynamic and angiographic assessment.

    The main findings of the study include: A MitraScore ≤3 was found in 71% of patients, 29.0% had MitraScore ≥4. One-year mortality was significantly lower in patients with nonrelevant residual MR (14.6% vs. 22.1%), and there was a linear relationship between worsening residual MR and mortality. The combined clinical endpoint of mortality and rehospitalization within the 1-year follow-up was also significantly lower in the MitraScore ≤3  group (31.5%) than in the MitraScore ≥4 group (40.8%) and effect of residual MR was not modified by MR etiology (primary, secondary, mixed).

    Eustachio Agricola, MD, and Francesco Ancona, MD of San Raffaele Scientific Institute, Milan, wrote the editorial comment. The editorialists stated that this study serves to aid the standardization of procedural success assessment after mitral TEER. They also highlighted a higher rate of right ventricular dysfunction and severity of tricuspid regurgitation at baseline in the MitraScore ≥4 group, which could confound the perceived effect of residual MR on outcomes. 

    Nevertheless, the expert commenters concluded: “First, the data of the present study confirm once again that the goal of the TEER procedure is to achieve the optimal result (no or mild residual MR vs mitral valve gradient and area). This should be pursued whenever possible due to the nearly linear correlation between residual MR and outcome.”


    Boekstegers P, Hausleiter J, Schmitz T, et al. Intraprocedural Residual Mitral Regurgitation and Survival After Transcatheter Edge-to-Edge Repair: Prospective German Multicenter Registry (MITRA-PRO). JACC Cardiovasc Interv. 2023;16:574–585.

    Agricola E, Ancona F. Multiparametric Approach for Result Assessment During Transcatheter Edge-to-Edge Repair: Is it the Key for Clinical Success? JACC Cardiovasc Interv. 2023;16:586–588.

    Image Credit: ibreakstock –

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