{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:43:41Z","timestamp":1792698221463,"version":"4.5.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Mitral valve edge-to-edge repair (M-TEER) is increasingly being used for the treatment of severe mitral regurgitation; however, outcomes in inoperable patients with very complex or even unfavourable mitral valve (MV) disease as \u2018ultima ratio\u2019 are unknown. The study aimed to evaluate patient outcomes according to mitral valve anatomical complexity, as suggested in a recent review article.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In this single-centre, retrospective analysis, consecutive patients who underwent M-TEER were categorized as \u2018Non-Complex\u2019 (NC), \u2018Complex\u2019 (C), \u2018Very Complex\u2019 (VC), and \u2018Ultimately Complex\u2019 (UC). Study endpoints were MR reduction, symptomatic improvement as expressed by changes in New York Heart Association (NYHA) functional class and two-year survival. The study included 789 consecutive patients at a mean age of 74.9 \u00b1 11.1 years (42.7% female; 49% with secondary and 51% with primary or mixed MV disease). 203 patients (25.7%), 409 patients (51.8%), 138 patients (17.5%), and 39 patients (4.9%) were classified as NC, C, VC, UC, respectively. Improvement to NYHA functional class \u2264 II and 2-year survival rates were comparable across anatomical complexity groups (NYHA \u2264 II: 68.4%, 61.8%, 63.5%, and 75.0%, P = 0.454; survival: 64.6%, 71.2%, 68.0%, and 71.0%; P = 0.454; for NC, C, VC, and UC, respectively). MR reduction was observed in all categories and it was comparable in secondary MV disease, while increasing MV complexity was associated with an increasing prevalence of residual MR \u22653 + in primary MR (7.9%, 8.3%, 10.9%, and 23.0% for NC, C, VC, and UC, respectively; P = 0.002).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides the first large-scale validation of a recently proposed mitral valve complexity framework. Anatomical complexity showed an etiology-specific impact, with no relevant effect on MR reduction or clinical outcomes in SMR, but increasing residual MR in primary disease. Given an acceptable rate of MR reduction, M-TEER can even be considered in selected patients with unfavourable MV anatomy as \u2018ultima ratio\u2019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeag035","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T12:41:19Z","timestamp":1769604079000},"page":"1047-1058","source":"Crossref","is-referenced-by-count":5,"title":["Impact of mitral valve complexity on outcomes following transcatheter mitral valve edge-to-edge repair"],"prefix":"10.1093","volume":"27","author":[{"given":"Sebastian","family":"Hausleiter","sequence":"first","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistr. 15, Munich D-81377 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludwig T","family":"Weckbach","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistr. 15, Munich D-81377 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas J","family":"Stocker","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistr. 15, Munich D-81377 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp M","family":"Doldi","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistr. 15, Munich D-81377 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Gmeiner","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistr. 15, Munich D-81377 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Novotny","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistr. 15, Munich D-81377 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7387-3986","authenticated-orcid":false,"given":"Steffen","family":"Massberg","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistr. 15, Munich D-81377 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"N\u00e4bauer","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistr. 15, Munich D-81377 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Stolz","sequence":"additional","affiliation":[{"name":"Medizinische Klinik und Poliklinik I, Klinikum der Universit\u00e4t M\u00fcnchen , Marchioninistr. 15, Munich D-81377 ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"2026042919570509700_jeag035-B1","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.jacc.2015.02.009","article-title":"Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and therapeutic considerations","volume":"65","author":"Asgar","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2026042919570509700_jeag035-B2","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.jcmg.2024.01.012","article-title":"The evolving concept of secondary mitral regurgitation phenotypes: lessons from the M-TEER trials","volume":"17","author":"Stolz","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026042919570509700_jeag035-B3","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.1016\/j.jcin.2024.08.016","article-title":"Long-term outcomes after edge-to-edge repair of secondary mitral regurgitation","volume":"17","author":"Stocker","year":"2024","journal-title":"JACC Cardiovasc Interv"},{"key":"2026042919570509700_jeag035-B4","doi-asserted-by":"crossref","first-page":"2307","DOI":"10.1056\/NEJMoa1806640","article-title":"Transcatheter mitral-valve repair in patients with heart failure","volume":"379","author":"Stone","year":"2018","journal-title":"N Engl J Med"},{"key":"2026042919570509700_jeag035-B5","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1056\/NEJMoa2314328","article-title":"Transcatheter valve repair in heart failure with moderate to severe mitral regurgitation","volume":"391","author":"Anker","year":"2024","journal-title":"N Engl J Med"},{"key":"2026042919570509700_jeag035-B6","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.jacc.2011.08.067","article-title":"Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVEREST II (endovascular valve edge-to-edge repair) high risk study","volume":"59","author":"Whitlow","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"2026042919570509700_jeag035-B7","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s00392-013-0614-x","article-title":"Percutaneous interventional mitral regurgitation treatment using the mitra-clip system","volume":"103","author":"Boekstegers","year":"2014","journal-title":"Clin Res Cardiol"},{"key":"2026042919570509700_jeag035-B8","doi-asserted-by":"crossref","first-page":"957","DOI":"10.4244\/EIJ-D-22-00725","article-title":"Mitral valve transcatheter edge-to-edge repair","volume":"18","author":"Hausleiter","year":"2023","journal-title":"EuroIntervention"},{"key":"2026042919570509700_jeag035-B9","doi-asserted-by":"crossref","first-page":"213","DOI":"10.4244\/EIJ-D-21-00708","article-title":"Management of patients with mitral regurgitation ineligible for standard therapy undergoing TMVI screening","volume":"18","author":"Ludwig","year":"2022","journal-title":"EuroIntervention"},{"key":"2026042919570509700_jeag035-B10","first-page":"137","article-title":"Percutaneous edge-to-edge repair of the mitral valve in patients with degenerative versus functional mitral regurgitation","volume":"84","author":"Braun","year":"2014","journal-title":"Catheter Cardiovasc Interv"},{"key":"2026042919570509700_jeag035-B11","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1007\/s00392-021-01961-5","article-title":"Impact of asymmetric tethering on outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation","volume":"111","author":"Stolz","year":"2021","journal-title":"Clin Res Cardiol"},{"key":"2026042919570509700_jeag035-B12","doi-asserted-by":"crossref","first-page":"e011562","DOI":"10.1161\/CIRCINTERVENTIONS.121.011562","article-title":"Coaptation reserve predicts optimal reduction in mitral regurgitation and long-term survival with transcatheter edge-to-edge repair","volume":"15","author":"Sato","year":"2022","journal-title":"Circ Cardiovasc Interv"},{"key":"2026042919570509700_jeag035-B13","doi-asserted-by":"crossref","first-page":"2462","DOI":"10.1016\/j.jcin.2019.09.014","article-title":"Impact of the leaflet-to-Annulus Index on residual mitral regurgitation in patients undergoing edge-to-edge mitral repair","volume":"12","author":"Tabata","year":"2019","journal-title":"JACC Cardiovasc Interv"},{"key":"2026042919570509700_jeag035-B14","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1016\/j.jacc.2021.11.041","article-title":"A score to assess mortality after percutaneous mitral valve repair","volume":"79","author":"Raposeiras-Roubin","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2026042919570509700_jeag035-B15","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1016\/j.jcin.2021.03.050","article-title":"Impact of residual mitral regurgitation on survival after transcatheter edge-to-edge repair for secondary mitral regurgitation","volume":"14","author":"Higuchi","year":"2021","journal-title":"JACC Cardiovasc Interv"}],"container-title":["European Heart Journal - Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/advance-article-pdf\/doi\/10.1093\/ehjci\/jeag035\/66632154\/jeag035.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/27\/5\/1047\/66632154\/jeag035.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article-pdf\/27\/5\/1047\/66632154\/jeag035.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T23:57:14Z","timestamp":1777507034000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcimaging\/article\/27\/5\/1047\/8444700"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":15,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,1,29]]},"published-print":{"date-parts":[[2026,4,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjci\/jeag035","relation":{},"ISSN":["2047-2404","2047-2412"],"issn-type":[{"value":"2047-2404","type":"print"},{"value":"2047-2412","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,1,29]]}}}