Real-World Outcomes After Simplified M-TEER Repair Under Sole TEE Guidance

This single-center, real-world study compared a simplified, fluoroscopy-free mitral transcatheter edge-to-edge repair (M-TEER) workflow guided solely by transesophageal echocardiography (TEE) against the conventional approach using combined fluoroscopic and TEE guidance. Among 386 patients treated between 2021 and 2025 (286 sole-TEE, 100 combined), technical success was high in both groups (98.3 percent vs 97.0 percent) and 30-day major adverse events were low (2.8 percent vs7.0 percent), with no significant differences. Over a median follow-up of 16.5 months, the adjusted hazard ratios for cardiovascular mortality, all-cause mortality, and the composite of all-cause mortality with heart failure hospitalization were 1.52, 0.96, and 0.93, respectively; none reaching significance. M-TEER failure at one year was similar (4.8 percent vs 6.3 percent), and results held across propensity-matched and overlap-weighted sensitivity analyses. The authors conclude that sole-TEE-guided M-TEER is feasible with favorable outcomes in experienced centers.