{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T07:15:22Z","timestamp":1793517322806,"version":"4.5.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Ulm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Recent developments in transcatheter mitral valve repair (M-TEER) have expanded the indication for the procedure beyond conventional criteria to include patients with anatomically complex degenerative mitral regurgitation (DMR), but long-term outcomes are not well known.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Aims<\/jats:title>\n            <jats:p>To investigate outcomes by specific anatomical criteria in patients with severe DMR and complex valve anatomy enrolled in the prospective MitraUlm registry.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Clinical and echocardiographic 3-year outcomes of 304 patients with DMR and complex mitral valve anatomy, defined according to the CLASP IID registry criteria, were investigated. Outcomes were analysed separately for specific anatomical complexities.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>33.5% of patients had\u2009\u2265\u2009independent significant jets, 12% multisegmental prolapse, 12.3% mitral valve orifice area\u2009&lt;\u20094 cm<jats:sup>2<\/jats:sup>, 10.9% commissural lesions with wide\/multiple jets, and 10.1% large flail. Mitral regurgitation (MR) reduction\u2009\u2264\u20092 was achieved in 93.8% of patients at discharge and in 85.9% at 3-year follow-up. Patients with multisegmental prolapse and commissural lesions with multiple\/wide jets had the lowest MR reduction at discharge. Compared to patients treated with MitraClip Generation 1\u20133, patients treated with MitraClip Generation 4 had significantly better post-procedural MR reduction (MR\u2009\u2264\u20091 in 74.3% vs 50.7%, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) and higher 3-year survival rates (80.2% vs 61.6%, Log Rank <jats:italic>P<\/jats:italic>\u2009=\u20090.002<jats:italic>)<\/jats:italic>. Postprocedural MR reduction to MR\u2009\u2264\u20091 was the strongest independent predictor of 3-year survival, whereas the presence of at least two anatomical complexities and elevated post-procedural left atrial pressure predicted 3-year all-cause mortality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>In patients with anatomically complex DMR, advances in procedural techniques for M-TEER have allowed successful treatment with sustained MR reduction and improved long-term survival.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00392-025-02644-1","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T10:57:24Z","timestamp":1744628244000},"page":"904-914","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Transcatheter edge-to-edge repair in anatomically complex degenerative mitral regurgitation: 3-year outcomes from a real-world registry"],"prefix":"10.1007","volume":"114","author":[{"given":"Nicoleta","family":"Nita","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Paukovitsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Felbel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Gr\u00f6ger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominik","family":"Buckert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam","family":"Ke\u00dfler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Rottbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"issue":"23","key":"2644_CR1","doi-asserted-by":"publisher","first-page":"2820","DOI":"10.1016\/j.jcin.2023.10.020","volume":"16","author":"RL Smith","year":"2023","unstructured":"Smith RL, Lim DS, Gillam LD et al (2023) 1-year outcomes of transcatheter edge-to-edge repair in anatomically complex degenerative mitral regurgitation patients. 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