Outcomes of Transcatheter Edge-to-Edge Mitral Valve Repair in Hypertrophic Cardiomyopathy: A Patient-Level Meta-Analysis

Q: What conditions in hypertrophic cardiomyopathy motivate using TEER?

HCM commonly involves LVOT obstruction and mitral regurgitation (MR). TEER is considered when both LVOT obstruction and concurrent MR are present, particularly for patients with limited alternatives.

Q: Which outcomes were analyzed in the patient-level meta-analysis?

The analysis included pre- and post-TEER measures such as peak resting or provoked LVOT gradients, MR grade, mitral valve gradients, and NYHA functional class.

Q: What improvements were observed after TEER?

TEER was associated with significant reductions in mean peak resting and provoked LVOT gradients and median MR grade, along with a marked decrease in the proportion of patients with NYHA functional class ≥3.

Sep 29, 2026

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Hypertrophic cardiomyopathy (HCM) is frequently complicated by left ventricular outflow tract (LVOT) obstruction and mitral regurgitation (MR). Transcatheter edge-to-edge repair (TEER) for MR in HCM is used when patients have LVOT obstruction and concurrent MR, yet outcome evidence remains limited. A systematic review and patient-level meta-analysis evaluated pre- and post-TEER LVOT gradients, MR grade, mitral valve gradients, and NYHA class, including published studies and one unpublished case.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Background on HCM and LVOT obstruction

Mitral regurgitation mechanisms and clinical management

Methods

Results

Conclusions

Structural Heart 9 (2025) 100664 Articles and Issues Available at ScienceDirect Structural Heart journal [homepage:](homepage: www.structuralheartjournal.org)[ www.structuralheartjournal.org](homepage: www.structuralheartjournal.org) | Original Research
Outcomes of Transcatheter Edge-to-Edge Mitral Valve Repair in Hypertrophic Cardiomyopathy: A Patient-Level Meta-Analysis | | | | | --- | --- | --- | --- | | Lorraine Mascarenhas, DO a, * , Gloria Yang, BSb , Alok Sharma, MDb, Stefan Bertog, MDb, Scott Hubers, MDb, 1, Selcuk Adabag, MD, MS b, 1
a Cardiology Division, Baylor College of Medicine, Houston, Texas, USA
b Cardiology Division, Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota, USA | | | | | A R T I C L E I N F O | | A B S T R A C T | | | Article history:
Submitted 3 September 2024
Revised 5 May 2025
Accepted 21 May 2025
Available online 6 June 2025 | | Background: Hypertrophic cardiomyopathy (HCM) is commonly associated with left ventricular outﬂow tract (LVOT) obstruction and mitral regurgitation (MR). Transcatheter edge-to-edge repair (TEER) of the mitral valve has been introduced as a therapeutic alternative for individuals with LVOT obstruction and concurrent MR, but there are insufﬁcient outcome data. We aim to perform a systematic review and patient-level meta-analysis of the studies reporting the outcomes of TEER of the mitral valve in HCM.
Methods: Original studies published in PubMed and Google Scholar were included if 􀀁1 of the following pre-and post-TEER measures were reported: peak resting or provoked LVOT gradients, MR grade, mitral valve gradient, or New York Heart Association (NYHA) functional class. One unpublished case from the Minneapolis Veterans Affairs Medical Center was also included.
Results: Nineteen publications and 37 patients (mean age 70.1 [􀀃 15.2] years, 50% male, mean follow-up time of 9.2 [􀀃6.4] months) were analyzed. Compared to baseline measurements, there was a signiﬁcant reduction in the mean peak resting and provoked LVOT gradients (69.2 [􀀃40.3] mmHg vs. 11.7 [􀀃8.6] mmHg and 98.2 [􀀃53.4] mmHg vs. 14.1 [􀀃 13.9] mmHg, respectively), median MR grade (4.0 [3.0-4.0] vs. 1.0 [1.0-1.0]), and proportion of patients with an NYHA functional class 􀀁3 (100 vs. 7%) post-TEER (all p < 0.001). There was a signiﬁcant increase in mean mitral valve gradients post-TEER (2.2 [􀀃 1.0] mmHg vs. 4.3 [􀀃 1.3] mmHg, p < 0.001). Conclusions: TEER can be an effective therapeutic option for improving LVOT obstruction, MR severity, and NYHA functional class in patients with HCM.
HCM, hypertrophic cardiomyopathy; LVOT, left ventricular outﬂow tract; MR, mitral regurgitation; NYHA, New York Heart Association; SAM, systolic anterior motion of the mitral valve; TEER, transcatheter edge-to-edge repair. | | | Keywords:
Hypertrophic cardiomyopathy Mitral valve
Transcatheter-edge-to-edge repair
A B B R E V I A T I O N S | | | | Introduction With an estimatedprevalence of0.2%to0.5%worldwide, hypertrophic cardiomyopathy (HCM) is one of the most common genetic cardiovascular disorders. Individuals with HCM have an increased risk for heart failure, arrhythmias, and sudden cardiac death.1-8 The deﬁning feature of HCM is interventricular septal hypertrophy leading to left ventricular outﬂow tract (LVOT) obstruction at rest and/or with provocation. This is seen in about 70% of HCM cases and leads to substantial pressure gradients between the left ventricle and aorta.9-11 HCM is also associated with systolic anterior motion of the mitral valve (SAM), which occurs because rapid ejection of blood through the narrowed LVOT produces “drag” forces that draw the anterior mitral valve leaﬂet toward the septum. SAM is further augmented by HCM-associated elongation of the anterior mitral leaﬂet and enlargement and displacement of the papillary muscles.12 In addition to causing LVOT obstruction, SAM is also associated with mitral regurgitation (MR) because th

FAQs

What conditions in hypertrophic cardiomyopathy motivate using TEER?

HCM commonly involves LVOT obstruction and mitral regurgitation (MR). TEER is considered when both LVOT obstruction and concurrent MR are present, particularly for patients with limited alternatives.

Which outcomes were analyzed in the patient-level meta-analysis?

The analysis included pre- and post-TEER measures such as peak resting or provoked LVOT gradients, MR grade, mitral valve gradients, and NYHA functional class.

What improvements were observed after TEER?

TEER was associated with significant reductions in mean peak resting and provoked LVOT gradients and median MR grade, along with a marked decrease in the proportion of patients with NYHA functional class ≥3.

Sep 29, 2026

Uploaded by Terk