Outcomes of edge-to-edge mitral valve repair in patients with mitral regurgitation evaluated for heart transplantation

To the Editor, Advanced heart failure (HF) complicated by secondary mitral regurgitation is associated with a poor prognosis, and heart transplantation is the standard of care; however, donor scarcity requires bridge strategies.1 The MitraBridge registry2 evaluated the impact of transcatheter edge-to-edge repair (TEER) in patients considered for transplantation; however, its retrospective design and substantial loss to follow-up limit the strength of its conclusions. The primary endpoint of our study was to assess the impact of TEER on mortality and the composite endpoint of death, need for heart transplantation or emergency left ventricular assist device placement, and index HF-related hospitalization in a cohort of patients with advanced HF and significant secondary mitral regurgitation who were evaluated for transplantation. The secondary endpoint was to compare the rate of HF-related hospitalizations before and after TEER. We conducted a retrospective analysis of a single-center, prospective observational registry including all patients treated with TEER at a tertiary referral center in Spain. The Córdoba Research Ethics Committee approved the study, and all patients gave their prior written informed consent. We selected patients with advanced HF (defined as New York Heart Association [NYHA] functional class ≥ II, left ventricular ejection fraction ≤ 35%, at least 1 HF-related hospitalization, and age...