Why Patient Selection Is Critical in M-TEER and Other Valve Interventions
Why Patient Selection Is Critical in M-TEER and Other Valve Interventions
Source:
JACC: Published 4 September 2025.
Key Findings :
1. Reintervention risk: Reinterventions after failed mitral TEER (M-TEER) are linked with significantly worse outcomes, including higher mortality and more heart failure readmissions.
2. Large U.S. dataset: Analysis of ~13,000 Medicare patients (2013–2019) showed an overall 6% reintervention rate.
3. Treatment after failed M-TEER: Roughly half of the patients who required reintervention underwent a repeat procedure, while the rest were managed surgically.
4. Survival outcomes: Long-term survival was higher after surgical reintervention (61.3% at 3 years) compared with repeat M-TEER (44.8%), even though surgery after failed TEER is technically more challenging.
5. Conclusion: Careful patient selection and procedural success from the first attempt are essential to minimize the need for reintervention and improve outcomes.
Other Valves
• Aortic (TAVR): Redo TAVR (valve-in-valve) is generally safer and preferred over open surgery, especially in older or high-risk patients.
• Tricuspid (T-TEER/TTVR): Success depends on the device — such as a clip — firmly holding the valve leaflets so they come together and close properly, reducing regurgitation, along with preserved right-ventricular function. Poor selection leads to persistent regurgitation or early failure.
• Pulmonic (TPVR): Redo TPVR is often preferred; surgery is considered mainly in complex cases.
Durability & Complications :
• Durability: TAVR valves remain effective for ~8–10 years; M-TEER maintains MR reduction for ~5 years in most patients; TPVR durability is ~5–10 years depending on device; long-term tricuspid TEER data are still limited (~1–2 years).
• Complications: Major risks include death (1–4%), stroke (2–4%), bleeding (2–5%), need for pacemaker after TAVR (10–20%), and paravalvular leak (~5–15%); rates vary by valve type and patient profile.
Universal Principle :
Across all transcatheter valves A Heart Team approach is vital to reduce complications and improve long-term survival.
