Mitral transcatheter edge-to-edge repair (TEER) has proven to be a safe and effective treatment option in patients with primary mitral regurgitation (MR) at high or prohibitive surgical risk or those with secondary MR who remain symptomatic despite guideline-directed medical therapy (GDMT) and have favorable anatomy.1 Transcatheter mitral valve replacement (TMVR) is emerging as an important therapy for patients with symptomatic severe primary or secondary MR who are deemed high surgical risk and have unfavorable anatomy for TEER.2 Despite availability of multiple TMVR devices within the context of clinical trials, not all patients screened are suitable candidates for TMVR. As TEER is being reconsidered in these patients with challenging anatomies, outcomes of patients who screen failed for TMVR are not well understood. We sought to evaluate clinical, anatomic, and echocardiographic characteristics of patients who failed TMVR screening at our institution and compared clinical outcomes between patients undergoing MV surgery or TEER vs. those receiving GDMT alone.
