Real-World Outcomes after Simplified Mitral Valve Transcatheter Edge-to-Edge Repair under Sole Transesophageal Echocardiographic Guidance.
A simplified mitral valve transcatheter edge-to-edge repair (M-TEER) workflow under sole transesophageal echocardiographic (TEE) guidance, without fluoroscopy, has been developed. This study aimed to compare its real-world outcomes with the conventional procedures under the combined guidance of fluoroscopy and TEE.
We retrospectively analyzed 386 patients undergoing M-TEER between January 2021 and December 2025, including 286 in the Sole-TEE guidance group and 100 in the Combined guidance group. The primary endpoints were cardiovascular mortality, all-cause mortality, and a composite of all-cause mortality and heart failure hospitalization. Propensity score matching and overlap weighting were performed as sensitivity analyses.
Technical success was achieved in 98.3% and 97.0% of patients in the Sole-TEE and Combined guidance groups, respectively, and 30-day major adverse events occurred in 2.8% and 7.0%, respectively (p > 0.05). The median follow-up was 16.5 months. At 1 year, the estimated cumulative incidence rates of the three primary endpoints were 4.4%, 6.0%, and 11.3% in the Sole-TEE guidance group and 6.4%, 8.5%, and 11.3% in the Combined guidance group, respectively (p > 0.05). M-TEER failure at 1 year was 4.8% and 6.3%, respectively (p > 0.05). The corresponding adjusted hazard ratios (95% confidence intervals) for the three primary endpoints were 1.52 (0.61-3.79), 0.96 (0.42-2.18), and 0.93 (0.48-1.81), respectively. Findings were consistent in sensitivity and subgroup analyses.
In this real-world observational cohort, M-TEER performed under sole-TEE guidance was associated with favorable procedural and follow-up outcomes, supporting the feasibility of this simplified workflow in experienced centers.
We retrospectively analyzed 386 patients undergoing M-TEER between January 2021 and December 2025, including 286 in the Sole-TEE guidance group and 100 in the Combined guidance group. The primary endpoints were cardiovascular mortality, all-cause mortality, and a composite of all-cause mortality and heart failure hospitalization. Propensity score matching and overlap weighting were performed as sensitivity analyses.
Technical success was achieved in 98.3% and 97.0% of patients in the Sole-TEE and Combined guidance groups, respectively, and 30-day major adverse events occurred in 2.8% and 7.0%, respectively (p > 0.05). The median follow-up was 16.5 months. At 1 year, the estimated cumulative incidence rates of the three primary endpoints were 4.4%, 6.0%, and 11.3% in the Sole-TEE guidance group and 6.4%, 8.5%, and 11.3% in the Combined guidance group, respectively (p > 0.05). M-TEER failure at 1 year was 4.8% and 6.3%, respectively (p > 0.05). The corresponding adjusted hazard ratios (95% confidence intervals) for the three primary endpoints were 1.52 (0.61-3.79), 0.96 (0.42-2.18), and 0.93 (0.48-1.81), respectively. Findings were consistent in sensitivity and subgroup analyses.
In this real-world observational cohort, M-TEER performed under sole-TEE guidance was associated with favorable procedural and follow-up outcomes, supporting the feasibility of this simplified workflow in experienced centers.
Authors
Ma Ma, Wang Wang, Yan Yan, Wei Wei, Dong Dong, Liu Liu, Dong Dong, Zhao Zhao, Zhang Zhang, Fang Fang, Ouyang Ouyang, Wang Wang, Duan Duan, Xie Xie, Wang Wang, Li Li, Pan Pan
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