Evolution of Clinical Indications for Mitral Valve Transcatheter Edge-to-Edge Repair

Mitral valve transcatheter edge-to-edge repair (M-TEER) has evolved from a highly specialized intervention to an essential treatment option for patients with severe mitral regurgitation (MR) who are unsuitable candidates for surgery. Moreover, current guidelines support the use of M-TEER in both secondary MR and selected cases of primary MR. In addition to these established indications, data from clinical trials and registries indicate that M-TEER is associated with improved short-term outcomes compared with conservative therapy in acute MR after myocardial infarction, and is beneficial in more complex scenarios, such as advanced heart failure, hypertrophic obstructive cardiomyopathy, and mitral annulus calcification. Meanwhile, combined strategies, such as repairing the mitral and tricuspid valves simultaneously, adding M-TEER to transcatheter aortic valve replacement, or performing this procedure alongside left atrial appendage closure, are gaining ground as practical ways to address the broader needs of these high-risk patients. More recently, M-TEER has been used in patients with moderate MR, as this stage is now recognized to be associated with adverse outcomes. Overall, current evidence supports M-TEER as a safe and versatile therapy across an expanding range of clinical scenarios. Nonetheless, ongoing studies will help further clarify long-term outcomes and refine patient selection.