Expanding Accessibility: Multi-Center Experience of Mitral TEER Procedures Performed Without On-Site Cardiac Surgery Department

Background
Mitral regurgitation (MR) is one of the most prevalent valvular heart diseases. It results in progressive volume overload, left ventricular dysfunction, atrial fibrillation, pulmonary hypertension, and heart failure (HF). Optimal medical therapy (OMT) remains the cornerstone of managing secondary MR. However, patients who remain symptomatic despite OMT require timely intervention to prevent worsening cardiac remodeling and progression of HF. Transcatheter edge-to-edge repair (TEER) has emerged as an effective minimally invasive alternative, with studies such as COAPT and MATTERHORN demonstrating significant reductions in hospitalizations and mortality among selected patients.

Objective
Although TEER procedures are not formally required to be performed exclusively in centers with on-site cardiac surgery departments, in Israel, these procedures have historically only been conducted in such centers. This study reports, for the first time, on the efficacy and safety of TEER procedures performed in cardiology centers without on-site surgical departments. The aim is to provide insights into procedural outcomes, complications, and long-term prognosis through a comprehensive multi-center registry.

Methods
This prospective multi-center registry analyzes data from patients who underwent TEER procedures at cardiology centers without on-site surgical departments. The collected data include pre-procedural clinical profiles, echocardiographic findings, procedural metrics, and post-procedural outcomes. Recorded complications encompass vascular events, major bleeding, single-leaflet device attachment, tamponade, stroke, urgent surgical conversions, 30-day rehospitalizations, and mortality.

Results
To date, 34 patients have undergone TEER procedures at non-surgical centers, achieving 100% procedural success with significant reductions in MR severity. Detailed complication rates and outcomes will be reported for all procedures performed through April 2025.

Conclusion
This registry demonstrates that TEER procedures can be performed safely and effectively in centers without on-site surgical departments, achieving outcomes comparable to those observed in surgical centers. Expanding access to TEER has the potential to enhance treatment availability for patients with severe MR who are ineligible for surgery.