A new study suggests that for elderly patients with atrial functional mitral regurgitation (AFMR), transcatheter edge-to-edge repair (TEER) is associated with a lower risk of mortality and heart failure hospitalisation compared with conventional medical therapy. The findings come from a propensity score-based comparison of two large Japanese registries, OCEAN-Mitral and REVEAL-AFMR.¹

Methodology

This comparative study analysed data from patients with moderate or severe AFMR enrolled in two registries. The treatment group included 441 patients who underwent TEER from the OCEAN-Mitral registry, while the control group consisted of 640 patients who received medical therapy from the REVEAL-AFMR registry. The mean age of the total cohort was 80.1 years.

To address significant baseline differences between the groups, investigators used overlap weighting based on propensity scores to create well-balanced cohorts. The primary endpoint was a composite of all-cause mortality and heart failure (HF) hospitalisation. The secondary endpoint was all-cause mortality.¹

Results

After statistical adjustment, the analysis showed that TEER was associated with a significantly lower incidence of the primary endpoint (hazard ratio [HR] 0.65; 95% confidence interval [CI] 0.43–0.99; p=0.044). A similar benefit was observed for the secondary endpoint of all-cause mortality (HR 0.58; 95% CI 0.35–0.99; p=0.044).¹

The estimated 3-year incidence of the primary endpoint was 21.0% in the TEER group versus 44.3% in the medical therapy group. An exploratory subgroup analysis suggested that the favourable outcomes were most pronounced in patients who achieved mild or less residual mitral regurgitation (MR) after the TEER procedure. Event rates for patients with moderate or greater residual MR were comparable to those in the medical therapy group. These findings were consistent across multiple sensitivity analyses.¹

Interpretation

These real-world data provide important evidence supporting the use of TEER in the management of AFMR, a condition that predominantly affects an elderly, high-risk population with limited treatment options. The findings suggest that TEER may offer a clinically meaningful benefit over medical therapy alone, potentially reducing both mortality and HF-related hospital admissions. The results also highlight the critical importance of achieving effective MR reduction (to mild or less) to maximise the potential benefits of the procedure.

Next Steps

The authors acknowledge the observational nature of the study. They conclude that prospective, randomised controlled trials are warranted to confirm these findings and further clarify the role of TEER in the treatment of patients with AFMR.

This study was funded by Edwards Lifesciences, Medtronic Japan, Boston Scientific, Abbott Medical Japan, Daiichi Sankyo, the Uehara Memorial Foundation, and the Japan Society for the Promotion of Science KAKENHI.

Disclaimer

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References

1. Kaneko T, Kagiyama N, Okazaki S, 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. Eur Heart J. 2026;47(11):1304–1314. https://doi.org/10.1093/eurheartj/ehaf511