Zhi-Nan Lu MD , Xu-Nan Guo MD , Yu-tong Ke MD , Yihua He MD , Xianbao Liu MD , Zhengming Jiang MD , Xinmin Liu MD , Wenhui Wu MD , Yi-Da Tang MD , Dajun Chai MD , Yansong Guo MD , Yongjian Wu MD , Yat-Yin Lam MD , Nicolo Piazza MD, PhD , Guangyuan Song MD
{"title":"一种新的形态学分类指导经导管二尖瓣边缘对边缘修复二尖瓣返流","authors":"Zhi-Nan Lu MD , Xu-Nan Guo MD , Yu-tong Ke MD , Yihua He MD , Xianbao Liu MD , Zhengming Jiang MD , Xinmin Liu MD , Wenhui Wu MD , Yi-Da Tang MD , Dajun Chai MD , Yansong Guo MD , Yongjian Wu MD , Yat-Yin Lam MD , Nicolo Piazza MD, PhD , Guangyuan Song MD","doi":"10.1016/j.jacasi.2025.05.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Mitral commissural prolapse poses significant anatomical challenges that can hinder the effectiveness of transcatheter edge-to-edge repair (TEER).</div></div><div><h3>Objectives</h3><div>The aim of this study was to estimate the safety and effectiveness of applying a novel morphological classification to guide TEER in patients with commissural degenerative mitral regurgitation (DMR).</div></div><div><h3>Methods</h3><div>In this prospective, multicenter study across 18 centers in China, we classified patients with severe commissural DMR into 4 morphological types through detailed echocardiographic analysis. Customized TEER strategies were applied accordingly. Procedural success, clinical outcomes, echocardiographic parameters, and quality of life were assessed over a follow-up period, with a median follow-up of 18 months (Q1-Q3: 15-21 months).</div></div><div><h3>Results</h3><div>Among 540 patients screened, 126 (23.3%) exhibited commissural involvement. Tailored TEER strategies were successfully applied to 68 patients, achieving a technical success rate of 100% (n = 68 of 68; 95% CI: 0.933-1.000) and a device success rate of 97.1% (n = 66 of 68, 95% CI: 0.888-0.992). The 1-year follow-up revealed that 94.1% (n = 64 of 68; 95% CI: 0.849-0.981) of patients had residual mitral regurgitation of grade ≤2+, with 82.4% (n = 56 of 68; 95% CI: 0.708-0.902) at grade ≤1+, and no major complications. Additionally, significant improvements were noted in left ventricular dimensions and functional status.</div></div><div><h3>Conclusions</h3><div>Our results highlight the value of the morphological classification system in enhancing TEER for commissural DMR. By addressing specific anatomical challenges, this system promotes tailored interventions that optimize procedural success and improve patient outcomes.</div></div>","PeriodicalId":73529,"journal":{"name":"JACC. Asia","volume":"5 9","pages":"Pages 1137-1154"},"PeriodicalIF":0.0000,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Novel Morphological Classification to Guide Transcatheter Mitral Valve Edge-to-Edge Repair for Commissural Mitral Regurgitation\",\"authors\":\"Zhi-Nan Lu MD , Xu-Nan Guo MD , Yu-tong Ke MD , Yihua He MD , Xianbao Liu MD , Zhengming Jiang MD , Xinmin Liu MD , Wenhui Wu MD , Yi-Da Tang MD , Dajun Chai MD , Yansong Guo MD , Yongjian Wu MD , Yat-Yin Lam MD , Nicolo Piazza MD, PhD , Guangyuan Song MD\",\"doi\":\"10.1016/j.jacasi.2025.05.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Mitral commissural prolapse poses significant anatomical challenges that can hinder the effectiveness of transcatheter edge-to-edge repair (TEER).</div></div><div><h3>Objectives</h3><div>The aim of this study was to estimate the safety and effectiveness of applying a novel morphological classification to guide TEER in patients with commissural degenerative mitral regurgitation (DMR).</div></div><div><h3>Methods</h3><div>In this prospective, multicenter study across 18 centers in China, we classified patients with severe commissural DMR into 4 morphological types through detailed echocardiographic analysis. Customized TEER strategies were applied accordingly. Procedural success, clinical outcomes, echocardiographic parameters, and quality of life were assessed over a follow-up period, with a median follow-up of 18 months (Q1-Q3: 15-21 months).</div></div><div><h3>Results</h3><div>Among 540 patients screened, 126 (23.3%) exhibited commissural involvement. Tailored TEER strategies were successfully applied to 68 patients, achieving a technical success rate of 100% (n = 68 of 68; 95% CI: 0.933-1.000) and a device success rate of 97.1% (n = 66 of 68, 95% CI: 0.888-0.992). The 1-year follow-up revealed that 94.1% (n = 64 of 68; 95% CI: 0.849-0.981) of patients had residual mitral regurgitation of grade ≤2+, with 82.4% (n = 56 of 68; 95% CI: 0.708-0.902) at grade ≤1+, and no major complications. Additionally, significant improvements were noted in left ventricular dimensions and functional status.</div></div><div><h3>Conclusions</h3><div>Our results highlight the value of the morphological classification system in enhancing TEER for commissural DMR. By addressing specific anatomical challenges, this system promotes tailored interventions that optimize procedural success and improve patient outcomes.</div></div>\",\"PeriodicalId\":73529,\"journal\":{\"name\":\"JACC. Asia\",\"volume\":\"5 9\",\"pages\":\"Pages 1137-1154\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. 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A Novel Morphological Classification to Guide Transcatheter Mitral Valve Edge-to-Edge Repair for Commissural Mitral Regurgitation
Background
Mitral commissural prolapse poses significant anatomical challenges that can hinder the effectiveness of transcatheter edge-to-edge repair (TEER).
Objectives
The aim of this study was to estimate the safety and effectiveness of applying a novel morphological classification to guide TEER in patients with commissural degenerative mitral regurgitation (DMR).
Methods
In this prospective, multicenter study across 18 centers in China, we classified patients with severe commissural DMR into 4 morphological types through detailed echocardiographic analysis. Customized TEER strategies were applied accordingly. Procedural success, clinical outcomes, echocardiographic parameters, and quality of life were assessed over a follow-up period, with a median follow-up of 18 months (Q1-Q3: 15-21 months).
Results
Among 540 patients screened, 126 (23.3%) exhibited commissural involvement. Tailored TEER strategies were successfully applied to 68 patients, achieving a technical success rate of 100% (n = 68 of 68; 95% CI: 0.933-1.000) and a device success rate of 97.1% (n = 66 of 68, 95% CI: 0.888-0.992). The 1-year follow-up revealed that 94.1% (n = 64 of 68; 95% CI: 0.849-0.981) of patients had residual mitral regurgitation of grade ≤2+, with 82.4% (n = 56 of 68; 95% CI: 0.708-0.902) at grade ≤1+, and no major complications. Additionally, significant improvements were noted in left ventricular dimensions and functional status.
Conclusions
Our results highlight the value of the morphological classification system in enhancing TEER for commissural DMR. By addressing specific anatomical challenges, this system promotes tailored interventions that optimize procedural success and improve patient outcomes.
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