M-TEER: Challenging the Status Quo With Outcome-Driven Metrics | JACC Baran

Hosts Mitsuaki Sawano, MD, and Satoshi Shoji, MD welcome Dr. Hiroshi Tsunamoto to discuss his JACC study from the OCEAN-Mitral Registry, examining how transmitral pressure gradients (TMPG) and residual mitral regurgitation (MR) jointly determine outcomes after transcatheter edge-to-edge repair (M-TEER) for functional MR. In over 2,300 patients, higher postprocedural TMPG (≥5 mmHg) was consistently associated with worse 2-year outcomes, regardless of residual MR severity, while patients achieving MR ≤ mild with TMPG <5 mmHg had the best prognosis. This episode highlights a practical, nuanced concept for M-TEER success—optimizing the balance between MR reduction and mitral gradient, rather than focusing on MR alone.