Twenty years after the first human use of the MitraClip system (Abbott), mitral transcatheter edge-to-edge repair (M-TEER) has initiated a new era in the treatment of severe mitral regurgitation (MR). Following CE (European conformity) marking in 2008 and U.S. Food and Drug Administration approval for the treatment of primary (PMR) and secondary MR (SMR) in 2013 and 2019, respectively, M-TEER continues to address the unmet needs of thousands of patients who are not eligible for surgery. Several iterations have since been introduced, and the safety and efficacy of the technique have been demonstrated in several observational studies and randomised controlled trials123 with more than 200,000 patients treated mainly in Europe and the USA. In parallel, the development of the PASCAL device (Edwards Lifesciences), an alternative M-TEER system that was the first to involve independent leaflet capture, has broadened the range of therapeutic options, while showing comparable results in smaller studies45.
Nowadays, patients with growing anatomical complexity, going far beyond the initially defined EVEREST criteria6, are selected for M-TEER by increasingly experienced operators and imaging teams
