EFFICACY OF TRANSCATHETER EDGE-TO-EDGE MITRAL VALVE REPAIR IN PATIENTS WITH A 'NARROW' FIBROUS ANNULUS

Elena Z. Golukhova; Gulamzhan M. Dadabayev; Baizak A. Sagymbayev; Inessa V. Slivneva; Marina Yu. Mironenko; Karen A. Ter-Akopian; Arina M. Antonova; Karen V. Petrosian

doi:10.17802/2306-1278-2026-15-2-165-179

EFFICACY OF TRANSCATHETER EDGE-TO-EDGE MITRAL VALVE REPAIR IN PATIENTS WITH A 'NARROW' FIBROUS ANNULUS

Elena Z. Golukhova, Gulamzhan M. Dadabayev, Baizak A. Sagymbayev, Inessa V. Slivneva, Marina Yu. Mironenko, Karen A. Ter-Akopian, Arina M. Antonova, Karen V. Petrosian

https://doi.org/10.17802/2306-1278-2026-15-2-165-179

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Abstract

Highlights

Transcatheter edge-to-edge mitral valve repair in patients with a «small» mitral annulus and borderline mitral valve area demonstrated high technical success and a low rate of complications. In most cases, a significant reduction of mitral regurgitation to ≤ grade 2 was achieved while maintaining low transmitral gradients, thereby minimizing the risk of iatrogenic mitral stenosis. One-year follow-up outcomes confirmed the durability of both hemodynamic and clinical benefits in the majority of patients. These findings support the feasibility and safety of transcatheter mitral valve repair in carefully selected patients with anatomically «small» mitral valves when performed in specialized high-volume expert centers.

Aim. To evaluate the efficacy and safety of transcatheter edge-to-edge mitral valve repair in patients with a «small» mitral annulus and initially limited mitral valve area.

Methods. The study included 46 patients with severe mitral regurgitation (grade 3–4) who underwent M-TEER at the A.N. Bakulev National Medical Research Center for Cardiovascular Surgery. The mean age was 68.9 ± 8 years. Most patients had functional MR (atrial or ventricular type) and a “small” mitral annulus with an annular area ranging from 32 to 36 cm² (median 35 cm²), while the mean mitral valve area was 4.1 cm². Clinical and echocardiographic assessments were performed before the procedure, in the early postoperative period, and at 1-year follow-up in 16 patients (34.7%). The evaluation included mitral regurgitation (MR) severity, transmitral pressure gradient, left ventricular remodeling function, and the incidence of complications.

Results. Technical success of M-TEER was achieved in 44 of 46 patients (95.6%). Non-fatal in-hospital complications occurred in 3 patients (6.5%), and no procedure-related mortality was observed. In the early postoperative period, MR severity was reduced to ≤ grade 2 in 95.5% of patients; residual severe MR (grade 3) was present in only 4.5%, and no cases of grade 4 MR were recorded. The median mean transmitral gradient increased from 2 to 3 mmHg, remained within a low range, and did not differ between atrial and ventricular MR. At 1-year follow-up (n = 16), 75% of patients still had MR ≤ grade 2, with no cases of grade 4 MR. The mean transmitral gradient remained stable, and left ventricular ejection fraction was preserved or moderately improved, particularly in patients with ventricular MR. No evidence of progressive iatrogenic mitral stenosis was detected.

Conclusion. Transcatheter edge-to-edge mitral valve repair in patients with a «small» mitral annulus demonstrated high technical success, a low complication rate, and sustained reduction of mitral regurgitation while maintaining low transmitral gradients. M-TEER may be considered an effective and safe alternative to surgery in high-risk patients with borderline mitral valve area. However, such procedures should be performed in expert, high-volume specialized centers with extensive experience in transcatheter valvular interventions.