Early exploration of different approaches in transcatheter mitral valve edge-to-edge repair for mitral regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Shaopeng ^1,2 , MA Xiaozhong ¹ , TANG Yipeng ¹ , BAI Yunpeng ¹ , CHEN Qingliang ¹ ,  JIANG Nan ¹ ,  ZHAO Feng ¹

1. Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, 300051, P. R. China;
2. Graduate School of Tianjin Medical University, Tianjin, 300051, P. R. China;

Corresponding?author：

JIANG Nan, Email: jiangnantj@126.com; ZHAO Feng, Email: zhaofeng7815@163.com

Keywords：

Mitral regurgitation; edge-to-edge; approach; trans-apical

DOI：

10.7507/1007-4848.202507076

Video：

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Objective To compare the differences of transcatheter edge-to-edge repair (TEER) between trans-apical and trans-femoral groups in the treatment of mitral regurgitation. Methods A retrospective study was conducted on the patients who underwent TEER surgery at Tianjin Chest Hospital from February 2023 to October 2024. Patients were divided into two groups based on the surgical approach: trans-apical approach group and trans-femoral approach group. Baseline conditions, perioperative and postoperative 6-month survival status, and echocardiographic follow-up indicators were collected and compared between the groups. The primary endpoint indicators were all-cause mortality and device success rate. Secondary endpoint indicators included catheterization duration, heart failure readmission rate, and incidence of moderate or greater mitral regurgitation. Results A total of 33 patients were included, with 16 in the trans-femoral approach group and 17 in the trans-apical approach group. The average age was (69.85±7.86） years, and 17 patients (51.5%) were male. There were no statistically significant differences between the two groups in demographic characteristics, STS scores, comorbidities (except for diabetes), and laboratory tests. The proportion of patients with preoperative heart function≥grade Ⅲ was higher in the trans-apical approach group (88.2% vs. 43.8%, P=0.007), and the left ventricular end-diastolic diameter was smaller [(58.41±7.13）mm vs. (65.81±11.58) mm, P=0.033]. The catheterization operation time was shorter in the trans-apical approach group [40.00 (30.00, 61.00) min vs. 74.00 (56.25, 108.25) min, P=0.002]. There were no statistically significant differences between the two groups in all-cause mortality, device success rate, and heart failure readmission rate. Conclusion TEER surgeries via different approaches might have the same safety and efficacy. The trans-apical TEER surgery is simpler to operate, has a shorter learning curve, and is easier for beginners to master.

1.	李怡堅, 趙振剛, 馮沅, 等. 結構性心臟病介入治療的主要發展歷程及進展. 中華心血管病雜志, 2023, 51(10): 1022-1027.Li YJ, Zhao ZG, Feng Y, et al. The main development process and progress of interventional therapy for broussonetia papyrifera-related heart disease. Chin J Cardiol, 2023, 51(10): 1022-1027.
2.	Varshney AS, Shah M, Vemulapalli S, et al. Heart failure medical therapy prior to mitral transcatheter edge-to-edge repair: the STS/ACC Transcatheter Valve Therapy Registry. Eur Heart J, 2023, 44(44): 4650-4661.
3.	謝春梅, 朱達, 王首正, 等. 經導管二尖瓣緣對緣修復術的發展歷史、應用現狀和未來展望. 中華心血管病雜志, 2023, 51(8): 873-878.Xie CM, Zhu D, Wang SZ, et al. Development history, current application status, and future prospects of transcatheter mitral valve edge-to-edge repair. Chin J Cardiol, 2023, 51(8): 873-878.
4.	朱齊豐, 王建安. 經導管心臟瓣膜病介入治療領域的中國腳步. 中華心血管病雜志, 2023, 51(8): 806-808.Zhu QF, Wang JA. China's footsteps in the field of transcatheter valvular heart disease interventional therapy. Chin J Cardiol, 2023, 51(8): 806-808.
5.	中華醫學會心血管病學分會. 經導管二尖瓣緣對緣修復術的中國專家共識. 中華心血管病雜志, 2022, 50(9): 853-863.Chinese Society of Cardiology, Chinese Medical Association. Chinese expert consensus on transcatheter edge-to-edge mitral valve repair. Chin J Cardiol, 2022, 50(9): 853-863.
6.	Pan W, Long Y, Guo Y, et al. Transapical edge-to-edge repair system in high-risk patients with degenerative mitral regurgitation: a multicenter trial (CLAMP-2). JACC Cardiovasc Interv, 2023, 16(18): 2340-2342.
7.	潘翠珍, 潘文志, 周達新, 等. 二尖瓣經導管緣對緣修復的超聲心動圖操作規范中國專家共識. 中國介入心臟病學雜志, 2022, 30(10): 721-733.Pan CZ, Pan WZ, Zhou DX, et al. Chinese expert consensus on the standardized ultrasonic cardiogram procedures for transcatheter edge-to-edge mitral valve repair. Chin J Interv Cardiol, 2022, 30(10): 721-733.
8.	Ge Z, Pan C, Li W, et al. Real-time monitoring and step-by-step guidance for transapical mitral valve edge-to-edge repair using transesophageal echocardiography. J Interv Cardiol, 2021, 2021: 6659261.
9.	Stone GW, Adams DH, Abraham WT, et al. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions: a consensus document from the Mitral Valve Academic Research Consortium. Eur Heart J, 2015, 36(29): 1878-1891.
10.	Stolz L, Stocker TJ, Lurz P, et al. Growing evidence for edge-to-edge repair in secondary mitral regurgitation: what to learn from COAPT, MITRA-FR, and RESHAPE-HF2. JACC Cardiovasc Interv, 2025, 18(7): 927-932.
11.	Chikwe J, Chen Q, Bowdish ME, et al. Surgery and transcatheter intervention for degenerative mitral regurgitation in the United States. J Thorac Cardiovasc Surg, 2025, 169(1): 80-88. e19.
12.	Rosch S, K?sser L, Besler C, et al. Short-term effects of different transcatheter edge-to-edge devices on mitral valve geometry. J Am Heart Assoc, 2023, 12(17): e030333.
13.	Chen J, Yang Y, Wei L. One-stage transcatheter aortic valve replacement and transcatheter edge-to-edge repair for aortic and mitral regurgitation. Eur Heart J, 2023, 44(15): 1377.
14.	Li W, Long Y, Pan W, et al. Transcatheter edge to edge repair using the ease-of-use valve clamp system for functional mitral regurgitation: a primary report. Surg Today, 2023, 53(1): 90-97.
15.	Long Y, Pan W, Pan C, et al. Transcatheter mitral valve edge-to-edge repair with a novel system. Int Heart J, 2022, 63(1): 23-29.
16.	Alabdaljabar MS, Almiro A, Khan J, et al. The clinical impact of mitral gradient post transcatheter edge-to-edge repair: a systematic review and meta-analysis. Catheter Cardiovasc Interv, 2025, 105(2): 413-425.
17.	Cabrucci F, Baudo M, Magouliotis DE, et al. Mitral valve surgery after failed transcatheter edge-to-edge repair: a meta-analysis. Can J Cardiol, 2025, 41(5): 813-828.
18.	林心平, 胡王興, 朱齊豐, 等. 經導管二尖瓣緣對緣修復術在交界脫垂解剖患者中應用策略的單中心經驗. 中華心血管病雜志, 2025, 53(4): 356-362.Lin XP, Hu WX, Zhu QF, et al. Single-center experience on the application strategy of transcatheter mitral valve edge-to-edge repair in patients with commissural prolapse anatomy. Chin J Cardiol, 2025, 53(4): 356-362.
19.	潘文志, 龍愉良, 周達新, 葛均波. 經導管二尖瓣緣對緣修復: 當前認識與策略原則. 中國胸心血管外科臨床雜志, 2024, 31(2): 181-184.Pan WZ, Long YL, Zhou DX, Ge JB. Transcatheter mitral valve edge-to-edge repair: current understanding and strategic principles. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(2): 181-184.

1. 李怡堅, 趙振剛, 馮沅, 等. 結構性心臟病介入治療的主要發展歷程及進展. 中華心血管病雜志, 2023, 51(10): 1022-1027.Li YJ, Zhao ZG, Feng Y, et al. The main development process and progress of interventional therapy for broussonetia papyrifera-related heart disease. Chin J Cardiol, 2023, 51(10): 1022-1027.
2. Varshney AS, Shah M, Vemulapalli S, et al. Heart failure medical therapy prior to mitral transcatheter edge-to-edge repair: the STS/ACC Transcatheter Valve Therapy Registry. Eur Heart J, 2023, 44(44): 4650-4661.
3. 謝春梅, 朱達, 王首正, 等. 經導管二尖瓣緣對緣修復術的發展歷史、應用現狀和未來展望. 中華心血管病雜志, 2023, 51(8): 873-878.Xie CM, Zhu D, Wang SZ, et al. Development history, current application status, and future prospects of transcatheter mitral valve edge-to-edge repair. Chin J Cardiol, 2023, 51(8): 873-878.
4. 朱齊豐, 王建安. 經導管心臟瓣膜病介入治療領域的中國腳步. 中華心血管病雜志, 2023, 51(8): 806-808.Zhu QF, Wang JA. China's footsteps in the field of transcatheter valvular heart disease interventional therapy. Chin J Cardiol, 2023, 51(8): 806-808.
5. 中華醫學會心血管病學分會. 經導管二尖瓣緣對緣修復術的中國專家共識. 中華心血管病雜志, 2022, 50(9): 853-863.Chinese Society of Cardiology, Chinese Medical Association. Chinese expert consensus on transcatheter edge-to-edge mitral valve repair. Chin J Cardiol, 2022, 50(9): 853-863.
6. Pan W, Long Y, Guo Y, et al. Transapical edge-to-edge repair system in high-risk patients with degenerative mitral regurgitation: a multicenter trial (CLAMP-2). JACC Cardiovasc Interv, 2023, 16(18): 2340-2342.
7. 潘翠珍, 潘文志, 周達新, 等. 二尖瓣經導管緣對緣修復的超聲心動圖操作規范中國專家共識. 中國介入心臟病學雜志, 2022, 30(10): 721-733.Pan CZ, Pan WZ, Zhou DX, et al. Chinese expert consensus on the standardized ultrasonic cardiogram procedures for transcatheter edge-to-edge mitral valve repair. Chin J Interv Cardiol, 2022, 30(10): 721-733.
8. Ge Z, Pan C, Li W, et al. Real-time monitoring and step-by-step guidance for transapical mitral valve edge-to-edge repair using transesophageal echocardiography. J Interv Cardiol, 2021, 2021: 6659261.
9. Stone GW, Adams DH, Abraham WT, et al. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions: a consensus document from the Mitral Valve Academic Research Consortium. Eur Heart J, 2015, 36(29): 1878-1891.
10. Stolz L, Stocker TJ, Lurz P, et al. Growing evidence for edge-to-edge repair in secondary mitral regurgitation: what to learn from COAPT, MITRA-FR, and RESHAPE-HF2. JACC Cardiovasc Interv, 2025, 18(7): 927-932.
11. Chikwe J, Chen Q, Bowdish ME, et al. Surgery and transcatheter intervention for degenerative mitral regurgitation in the United States. J Thorac Cardiovasc Surg, 2025, 169(1): 80-88. e19.
12. Rosch S, K?sser L, Besler C, et al. Short-term effects of different transcatheter edge-to-edge devices on mitral valve geometry. J Am Heart Assoc, 2023, 12(17): e030333.
13. Chen J, Yang Y, Wei L. One-stage transcatheter aortic valve replacement and transcatheter edge-to-edge repair for aortic and mitral regurgitation. Eur Heart J, 2023, 44(15): 1377.
14. Li W, Long Y, Pan W, et al. Transcatheter edge to edge repair using the ease-of-use valve clamp system for functional mitral regurgitation: a primary report. Surg Today, 2023, 53(1): 90-97.
15. Long Y, Pan W, Pan C, et al. Transcatheter mitral valve edge-to-edge repair with a novel system. Int Heart J, 2022, 63(1): 23-29.
16. Alabdaljabar MS, Almiro A, Khan J, et al. The clinical impact of mitral gradient post transcatheter edge-to-edge repair: a systematic review and meta-analysis. Catheter Cardiovasc Interv, 2025, 105(2): 413-425.
17. Cabrucci F, Baudo M, Magouliotis DE, et al. Mitral valve surgery after failed transcatheter edge-to-edge repair: a meta-analysis. Can J Cardiol, 2025, 41(5): 813-828.
18. 林心平, 胡王興, 朱齊豐, 等. 經導管二尖瓣緣對緣修復術在交界脫垂解剖患者中應用策略的單中心經驗. 中華心血管病雜志, 2025, 53(4): 356-362.Lin XP, Hu WX, Zhu QF, et al. Single-center experience on the application strategy of transcatheter mitral valve edge-to-edge repair in patients with commissural prolapse anatomy. Chin J Cardiol, 2025, 53(4): 356-362.
19. 潘文志, 龍愉良, 周達新, 葛均波. 經導管二尖瓣緣對緣修復: 當前認識與策略原則. 中國胸心血管外科臨床雜志, 2024, 31(2): 181-184.Pan WZ, Long YL, Zhou DX, Ge JB. Transcatheter mitral valve edge-to-edge repair: current understanding and strategic principles. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(2): 181-184.

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