A coaptation gap during TEER for functional MR resulted in a similar 3-year incidence of death, heart failure hospitalization, or reintervention compared to no gap (50.7% vs 52.9%, p=0.71).
Cohort (n=2,140)
Does the presence of a leaflet coaptation gap affect procedural and clinical outcomes in patients undergoing TEER for functional mitral regurgitation?
In patients undergoing TEER for functional MR, a baseline coaptation gap reduces procedural MR elimination but does not worsen 3-year clinical outcomes compared to those without a gap.
Absolute Event Rate: 50.7% vs 52.9%
p-value: p=0.71
Abstract Background Coaptation gap (CG) is one of the challenging anatomies of mitral transcatheter edge-to-edge repair (TEER), but its impact on patient outcomes is unclear. Purpose This study aimed to evaluate the impact of CG on procedural and clinical outcomes in patients with functional mitral regurgitation (MR). Methods Data from 2,140 patients undergoing TEER for functional MR were analyzed, focusing on the presence of CG, which is defined as a missing leaflet coaptation between the anterior and posterior leaflets during systole. The primary outcome was a composite of death, heart failure hospitalization, and mitral valve reintervention. Results Of 2140 patients, 219 patients had CG, which median length was 2.6 2.0–3.4 mm. In 219 patients with CG, baseline MR grade, New York Heart Association (NYHA) functional class, and baseline mean left atrial pressure (LAP) were more severe. Long and wide clip types were more frequently used in the procedure. After TEER, patients with CG had a significantly lower achievement of residual MR grade ≤2+ (92.7%) and ≤1+ (64.8%) than those without CG (97.1%, p0.01; 82.2%, p0.01; respectively). In patients with CG, logistic regression models with restricted cubic splines analysis showed that the log odds ratio of achievement of residual MR ≤ 1+ gradually decreased as CG length increased. However, mean LAP significantly decreased after TEER in both groups (p0.01 for both), with a greater reduction in mean LAP in the CG group compared to the non-CG group (p0.01). NYHA functional class at 1 year was similar in both groups. The cumulative incidence of the primary outcome was comparable between CG and non-CG groups (50.7% vs 52.9% at 3 years, p=0.71) (Figure 1). While residual MR grade 2+ was associated with the higher primary outcome incidence than residual MR grade ≤1+ in patients without CG (p0.01), no significant difference was found between the two groups in patients with CG (p=0.51) (Figure 2). Conclusion CG was associated with less MR reduction but did not affect adverse events and symptom control after TEER. Similar outcomes between residual MR grade 2+ and ≤1+ in CG patients highlight the importance of procedural endpoint in anatomically challenging cases.
Nishiura et al. (2025) conducted a cohort in functional mitral regurgitation (n=2,140). Transcatheter edge-to-edge repair (TEER) with coaptation gap vs. TEER without coaptation gap was evaluated on Composite of death, heart failure hospitalization, and mitral valve reintervention (p=0.71). A coaptation gap during TEER for functional MR resulted in a similar 3-year incidence of death, heart failure hospitalization, or reintervention compared to no gap (50.7% vs 52.9%, p=0.71).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: