Early Versus Delayed Transcatheter Edge-to-Edge Repair for Functional Mitral Regurgitation After Acute Decompensated Heart Failure: A Multicenter Real-World Analysis

Authors

• Mazen Ahmed, Corewell Health East Resident
• Ali A. Mohamedshata, Corewell Health East Resident
• Hind Abdulhay
• Mohamed Elhussain
• Mohamed Eltayeb
• Mohamed Elmojtaba Ahmed, Corewell Health East Resident
• Rayan Salih
• Mohammad Ali Sheffeh
• Saman Al Barznji
• Sam Alsabti, Corewell Health East Fellow
• Rita Coram, Corewell Health East
• M Chadi Alraies
• Mustafa M. Turkmani

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Journal of the Society for Cardiovascular Angiography & Interventions

Abstract

Background: The optimal timing of transcatheter edge-to-edge repair (TEER) after hospitalization for acute decompensated heart failure (ADHF) in patients with significant functional mitral regurgitation (FMR) remains unclear. While TEER improves outcomes in selected patients with FMR, real-world data addressing whether earlier intervention after ADHF confers additional benefit are limited. Methods: Using the TriNetX Global Collaborative Network, we identified adults hospitalized with ADHF and non-rheumatic MR who subsequently underwent TEER. Patients were stratified into early TEER (≤1 month) or delayed TEER (1–6 months) following ADHF. Outcomes were assessed from 31 to 365 days after the index event to minimize immortal time bias. Propensity score matching (1:1) was performed using 73 demographic, clinical, laboratory, and medication variables, including atrial fibrillation, chronic kidney disease, left ventricular ejection fraction, and GDMT. The primary outcome was heart failure (HF) readmission; secondary outcomes included all-cause mortality and acute kidney injury (AKI). Time-to-event analyses were performed using Cox proportional hazards models. Results: After matching, 219 patients were included in each cohort (mean age 77 years; >60% with atrial fibrillation and chronic kidney disease). Early TEER was associated with a significantly lower risk of HF readmission compared with delayed TEER (80.4% vs 87.7%; risk difference −7.3%, p=0.037). This reduction was consistent across key high-risk subgroups, including atrial fibrillation, chronic kidney disease, and reduced ejection fraction. Mortality was numerically lower with early TEER (7.3% vs 10.5%; hazard ratio 0.73, 95% CI 0.39–1.38; p=0.33), while AKI rates were similar between groups (22.8% vs 27.9%; p=0.23). High overall event rates reflected the advanced comorbidity burden of this real-world ADHF population. Conclusions: Among patients with ADHF and significant MR, early TEER within one month was associated with fewer recurrent HF hospitalizations without increased mortality or renal complications. These findings support earlier consideration of TEER following ADHF stabilization and warrant prospective evaluation of timing strategies.

Volume

5

Issue

4 Suppl

First Page

104443

Comments

Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions, April 23-25, 2026, Montreal, Canada

Last Page

104443

Recommended Citation

Ahmed M, Mohamedshata AA, Abdulhay H, Elhussain M, Eltayeb M, Ahmed ME, et al. [Alsabti S, Coram R]. Early versus delayed transcatheter edge-to-edge repair for functional mitral regurgitation after acute decompensated heart failure: a multicenter real-world analysis. J Soc Cardiovasc Angiogr Interv. 2026 Apr;5(4 Suppl):104443. doi:10.1016/j.jscai.2026.104443

DOI

10.1016/j.jscai.2026.104443