Shedding light on a new treatment for an understudied condition, data published in EHJ suggests that transcatheter edge-to-edge repair (TEER) delivers significant survival advantages in patients with atrial functional mitral regurgitation (FMR).
- Atrial FMR is increasingly recognized as an important consequence of chronic atrial fibrillation, affecting older patients with limited therapeutic options.
- The previous COAPT and RESHAPE-HF2 trials only established TEER’s benefits in ventricular FMR patients, but hadn’t explored its impact in atrial FMR.
The new OCEAN-Mitral/REVEAL-AFMR Analysis compared 441 TEER-treated patients against 640 medically managed controls with moderate or severe atrial FMR, stating a solid case for TEER…
- Primary endpoint risk (death + HF hospitalization) was 35% lower with TEER.
- All-cause mortality alone dropped by 42% with intervention.
Beyond meeting survival endpoints, TEER demonstrated progressive benefits over time and superior procedural outcomes, including…
- Far lower primary endpoint rates at 3 years (21.0% vs. 44.3%).
- Residual MR reduced to mild or less in 78.3% of patients at discharge.
- Procedural success rate of 95.2% with only 2.9% device-related complications.
So what do we do with these strong results? Researchers suggest emphasizing careful patient selection and TEER procedural optimization for this high-risk population such as…
- Targeting patients failing standard HF therapy who are functionally limited yet open to intervention.
- Selection based on MR severity, comorbidities, and left atrial size before extreme enlargement.
- Preprocedural echo assessment for identifying procedural difficulty factors.
The Takeaway
This registry analysis provides the first dedicated evidence that TEER can deliver striking mortality benefits in atrial FMR, a complex condition where effective medical therapies are still limited. However, it’s still only an observational study, so randomized trials will be needed to definitively prove this procedure’s role in atrial FMR treatment.
