Background Hemolytic anemia after surgical valve repair is rare but potentially life-threatening and has mostly commonly been described in the context of paravalvular regurgitation. Case Summary A 78-year-old woman with prior surgical mitral valve (MV) repair presented with progressive dyspnea and severe hemolytic anemia. Echocardiography revealed severe eccentric, valvular mitral regurgitation (MR) caused by anterior leaflet prolapse with a high-velocity regurgitant jet striking the annuloplasty ring. The patient underwent transcatheter mitral edge-to-edge repair (M-TEER), achieving reduction of MR to mild and resolution of hemolysis. Discussion This case highlights hemolysis as a rare complication after surgical MV repair and the utility of M-TEER for patients at prohibitive surgical risk. Take-Home Messages M-TEER may represent a safe and effective option for managing hemolytic anemia due to recurrent MR. Besides paravalvular regurgitation, valvular regurgitation in the context of prior surgical MV repair should be recognized as a potential cause of hemolytic anemia.

Background Transcatheter aortic valve replacement using self‐expandable valves requires permanent pacemaker implantation (PPI) more often compared with balloon‐expandable systems. The Navitor prosthesis is a novel, tubular‐shaped self‐expandable valve with increasing use. Methods Thirty‐day PPI rates were compared between 148 patients treated with the Navitor system and 165 patients treated with the Evolut system. Patients with preexisting PPI, high‐risk ECG (right bundle‐branch block), and Navitor 35‐mm/Evolut 34‐mm prostheses were excluded. Multivariable logistic regression was used to adjust for baseline differences. Results Patients treated with Navitor were older (83.0 [IQR, 78–86] versus 81.0 [IQR, 76–84] years; P < 0.01) and had higher Society of Thoracic Surgeons mortality risk (5.6% [IQR, 3.0%–9.9%] versus 4.3% [IQR, 2.5%–7.0%]; P = 0.04). Overall, PPI occurred more frequently with Navitor (17.6%) than with Evolut (6.7%; P < 0.01), and this difference persisted after adjustment (adjusted odds ratio, 3.07 [95% CI, 1.10–8.40]; P = 0.03; adjusted probability, 17.7% [95% CI, 15.1%–20.2%] versus 6.7% [95% CI, 5.5%–7.9%]). In patients with small annuli (<430 mm2), unadjusted PPI rate (9.1% versus 6.4%; P = 0.55) and adjusted probabilities were similar (7.8% [95% CI, 5.0%–10.6%] versus 6.4% [95% CI, 4.8%–8.0%]; interaction P = 0.03). Within the Navitor cohort, PPI was more frequent with 27/29 mm than with 23/25 mm prostheses (22.3% versus 6.7%; P=0.02). Implantation depth was greater in Navitor patients requiring PPI (5.3±1.8 versus 4.3±2.2 mm; P=0.04) and lower PPI rates (2.9% versus 30.8%; P<0.01) were observed with high target implantation depth. Conclusions Depending on prosthesis size, transcatheter aortic valve replacement with the Navitor system may have PPI rates comparable to other self‐expandable valves. High implantation of the Navitor may be attempted to reduce PPI rates.

Background: Transcatheter tricuspid edge-to-edge repair (T-TEER) is widely used to treat atrial (AFTR) and ventricular (VFTR) functional tricuspid regurgitation (FTR). Methods: The outcome of 136 patients treated with T-TEER for severe AFTR or VFTR was analyzed using a composite endpoint of all-cause death and rehospitalization for decompensated heart failure. AFTR was defined as TR in the context of left ventricular ejection fraction ≥50%, right ventricular fractional area change (RVFAC) ≥ 35% and sPAP ≤ 50 mmHg. Results: Patients with VFTR (N = 109) and AFTR (N = 27, 19.9%) were both elderly (82.0 {IQR: 74.5–84.5} vs. 82.0 {IQR: 75.0–84.0} years, p = 0.98) and had similar interventional risk according to the EuroScore II (6.1 {4.0–9.8} vs. 4.7 {3.6–9.6} %, p = 0.3). Atrial fibrillation was equally frequent in both groups (89.9 vs. 88.9%, p = 0.88). AFTR patients were significantly more often female (56.0 vs. 77.8%, p = 0.04) and had lower NT-proBNP (3600.0 {1706.0–6302.0} vs. 1988.0 {1034.8–3723.3} pg/mL, p < 0.01). While RVFAC (29.5 ± 8.6 vs. 42.1 ± 4.3%, p < 0.01) and LVEF (48.5 ± 12.3 vs. 58.6 ± 8.0%, p < 0.01) were expectedly lower in patients with VFTR, right atrial dilation (RA volume: 126.7 ± 56.5 vs. 127.6 ± 74.2 mL, p = 0.99) was similar. Successful T-TEER with TR reduction ≥ 2 degrees (96.3 vs. 92.6%, p = 0.34) was observed in both groups, and residual TR ≤ II was equally frequent (94.5 vs. 96.3%, p = 1.0). The incidence of the 1-year composite endpoint was significantly higher (34.3 vs. 12.0%) in patients with VFTR (log-rank p = 0.02). AFTR was inversely associated with the composite endpoint (HR: 0.21, 95% CI: 0.06–0.7, p < 0.01) in multivariate Cox regression. Conclusions: Despite equally effective TR reduction through T-TEER, a better outcome was observed in patients with AFTR.

Background/Objectives: In patients with transthyretin amyloid cardiomyopathy (ATTR-CM), the effect of tafamidis on right ventricular (RV) dysfunction has been poorly investigated. The purpose of this study was to evaluate the effect of tafamidis on RV free wall global longitudinal strain (RV FW-GLS) and right ventricular and pulmonary artery (RV-PA) coupling over 12 months of treatment. Methods: Ninety-three patients with ATTR-CM treated with 61 mg of tafamidis daily who underwent multimodality imaging evaluation at baseline by cardiovascular magnetic resonance (CMR) and speckle-tracking echocardiography were retrospectively studied. The 12-month follow-up included an echocardiographic assessment of RV FW-GLS and RV-PA coupling. RV reverse remodeling was defined as a >10% improvement in RV FW-GLS and/or in RV-PA coupling from baseline. RV-PA coupling was assessed using the tricuspid annular plane systolic excursion/ pulmonary artery systolic pressure (TAPSE/PASP) ratio. Results: Over 12 months of tafamidis treatment, RV reverse remodeling was documented in 22.6% of patients. In these patients, RV FW-GLS improved significantly from 14.5 ± 2.1% to 17.3 ± 2%, p < 0.001, whereas the TAPSE/PASP ratio improved from 0.42 ± 0.05 mm/mmHg to 0.54 ± 0.07 mm/mmHg, p = 0.001. Patients who experienced RV reverse remodeling were at an earlier stage of disease prior to tafamidis treatment with less dilated RV and less severe RV-PA uncoupling (TAPSE/PASP ratio: 0.43 ± 0.06 mm/mmHg vs. 0.39 ± 0.06 mm/mmHg, p = 0.040). CMR-derived baseline RV end-systolic volume (HR 0.83, 95% CI 0.73–0.94, p = 0.005) and NT-proBNP (HR 0.989, 95% CI 0.988–0.999, p = 0.024) were the strongest independent predictors of RV reverse remodeling, followed by PASP (HR 0.82, 95% CI 0.69–0.98, p = 0.030). Conclusions: Patients with ATTR-CM treated with tafamidis at an earlier stage of the disease experienced RV reverse remodeling with significant improvement in RV FW-GLS and RV-PA coupling.

Background: The prevalence of patients with cardiac sarcoidosis (CS) diagnosed at a subclinical stage has increased; however, their long-term outcomes are not well known. Objectives: To investigate the incidence and predictors of adverse long-term outcomes in newly diagnosed patients with asymptomatic CS. Methods: Forty-three patients with newly diagnosed asymptomatic CS and comprehensive baseline evaluation with cardiovascular magnetic resonance (CMR) were studied. Asymptomatic CS was defined as CS in patients with biopsy-proven extracardiac sarcoidosis without cardiac symptoms but with abnormalities on CMR or positron emission tomography according to Heart Rhythm Society criteria. The primary endpoint was a composite of all-cause mortality, new ventricular arrhythmia or an atrioventricular block requiring cardiac device implantation, and hospitalization for heart failure. Results: Patients had a mean age of 56 ± 11 years and presented with normal left ventricular (LV) ejection fraction (58 ± 4%). A total of 44.2% of patients reached the composite endpoint during 5 years of follow-up. Patients with the primary endpoint were predominantly female (73.7%) and had a significantly higher prevalence of right ventricular (RV) involvement compared to patients without the primary endpoint (RV late gadolinium enhancement (LGE) in 26.3% vs. 4.2%, p = 0.037). In multivariate regression analysis, extensive LV LGE (HR 1.61, 95% CI 1.16–2.04, p = 0.004) and impaired RV global longitudinal strain (GLS) at baseline (HR 0.46, 95% CI 0.24–0.68, p = 0.015) were significantly predictive of the primary endpoint, whereas treatment with corticosteroids after CS diagnosis was significantly associated with improved outcomes (HR 7.69, 95% CI 1.11–11.11, p = 0.044). Conclusions: Newly diagnosed patients with asymptomatic CS have a significant incidence of adverse outcomes after 5 years of follow-up. The extent of LV LGE and impaired RV GLS at baseline predict poor long-term outcomes in asymptomatic CS.

Cerebral embolic protection (CEP) reduces strokes during transcatheter aortic valve replacement (TAVR) but is not standard of care at most centers. To assess the impact of CEP use in real-world practice at a tertiary center using CEP as a standard of care during TAVR. In-hospital outcome of 2173 patients was compared to 328 (13.1 Two thousand five hundred one patients were analyzed according to CEP use. CEP could be used in the majority of patients, whereas a minority (13.1

Recent developments in transcatheter mitral valve repair (M-TEER) have expanded the indication for the procedure beyond conventional criteria to include patients with anatomically complex degenerative mitral regurgitation (DMR), but long-term outcomes are not well known. To investigate outcomes by specific anatomical criteria in patients with severe DMR and complex valve anatomy enrolled in the prospective MitraUlm registry. Clinical and echocardiographic 3-year outcomes of 304 patients with DMR and complex mitral valve anatomy, defined according to the CLASP IID registry criteria, were investigated. Outcomes were analysed separately for specific anatomical complexities. 33.5

CT-based opportunistic screening using artificial intelligence finds a high prevalence (43

Abstract Background ST-elevation myocardial infarction (STEMI) demands near-time reperfusion to reduce the risk of long-term heart failure. This study evaluates the proportion of impaired left ventricular ejection fraction (LVEF) following STEMI in the context of current healthcare settings at a tertiary care center equipped with the most advanced and up-to-date standards of care. Methods Patients experiencing STEMI as their first manifestation of coronary artery disease were analyzed, as these individuals had no prior experience with heart-related chest pain. LVEF was assessed by levocardiography at admission and semiautomatically using TOMTEC in patients with eligible full-cycle echocardiography of 2- and 4-chamber view available at discharge and 1-year follow-up (FU). Pain-to-balloon time was divided into quartiles (Q) [0-111, 112–159, 160–246 and 247–784 min]. Multiple logistic regression analysis identified independent predictors of reduced LVEF < 50% at 1-year FU. Results A total of 1,379 consecutive STEMI patients were reviewed from 2010 to 2017, with 130 meeting the inclusion criteria. Mean age was 63 ± 12 years, 75% were male, 14% had diabetes, 72% had arterial hypertension, and 56% had history of smoking. LVEF was reduced in 94% of patients at admission, 69% at discharge, and remained reduced in 45% at the 1-year follow-up. Anterior wall myocardial infarction (OR 3.2 [95%-CI 1.2–6.9], p = 0.018) and increasing pain-to-balloon time across quartiles (Q2: OR 15.7 [95%-CI 1.8–140.4], p = 0.014; Q4: OR 33.7 [3.4–278.7] p = 0.002) were independently associated with reduced LVEF at 1 year. Conclusion Despite optimal medical management and advanced healthcare structures, nearly half of patients with STEMI as their first presentation of coronary artery disease continue to exhibit reduced LVEF at 12-months. Anterior wall myocardial infarction and pain-to-balloon time exceeding 2 h remain independent predictors of left ventricular dysfunction. Further improvements in healthcare systems and public education are essential to reduce treatment delays and improve long-term outcomes.

Background:Despite the lack of randomized-controlled trials in patients with failed bioprosthetic valves, valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is increasingly used. Methods:Outcomes of consecutive patients treated with ViV-TAVR (N = 100) at our tertiary heart center between 2014 and 2022 were compared to TAVR (N = 2216) in native valves. Results:Patients median age was 78.5 years (IQR 70.0-84.0) in ViV-TAVR compared to 81.0 (IQR 77.0-85.0) in patients with native aortic stenosis (p < 0.01) with a similar percentage of females in both groups (42% vs. 49.3%, p = 0.18). The median Society of Thoracic Surgeons score for mortality was significantly higher in patients undergoing ViV-TAVR [5.1% {IQR 2.6%-8.6%} vs. 3.8% {IQR 2.4%-6.3%}, p < 0.01]. ViV-TAVR was performed in degenerated surgical bioprostheses in 88% and in degenerated transcatheter bioprostheses in 12%. Stenosis was the main mechanism of bioprosthetic valve failure (70%), whereas severe regurgitation was the leading cause in 30%. The overall rate of device success amounted to 66% in ViV-TAVR, compared to 96.1% in TAVR (p < 0.01) and ViV-TAVR was independently associated with reduced device success (OR: 0.07, 95%CI: 0.045-0.12, p < 0.01) in multivariate regression. While ViV-TAVR decreased peak and mean gradients significantly, in 31% of patients elevated mean gradients (≥20 mmHg) were observed at discharge. Small native prosthesis diameter (<20 mm) was the strongest predictor (OR 3.8, 95%CI: 1.5-9.2, p = 0.01) independently associated with elevated gradients after ViV-TAVR. Conclusion:ViV-TAVR for treatment of degenerated bioprostheses improves aortic valve function. However, device success is lower compared to TAVR in native aortic valve disease, mainly due to elevated postprocedural mean gradients, especially in small bioprostheses.

BackgroundSeveral studies have demonstrated an association between tricuspid regurgitation (TR) and organ dysfunction including hepatic and renal insufficiency. Improvement of liver function following transcatheter edge-to-edge repair (T-TEER) has already been linked to reduction of venous congestion due to TR reduction. This study analyzes whether TR-reduction using T-TEER is also associated with improved renal function.Methods and resultsThe TRIC-ULM registry includes 92 selected patients undergoing T-TEER between March 2017 and May 2023. Estimated glomerular filtration rate (eGFR) improvement was evident in 53 patients (57%) at 3-months follow-up (FU) and defined by FU eGFR > baseline eGFR. Median age was 80 [interquartile range 75–83] years, pre- and postinterventional TR grades were 4 [3–5] and 1 [1–2], baseline eGFR was 36 [30–53] ml/min and New Yeark Heart Association (NYHA) IV was evident in 15% of patients. Multiple logistic regression analysis revealed TR vena contracta reduction (Odds ratio (OR) 1.35 [95% CI: 1.12–1.64] per mm, p = 0.002) and reduced preinterventional tricuspid annular plane systolic excursion (TAPSE) [OR 0.89 (95% CI: 0.79–0.99) per mm, p = 0.033] to independently predict renal improvement at FU. An eGFR improvement threshold of >9 ml/min was associated with reduced 1-year heart failure hospitalization rates [adjusted hazard ratio 0.22 (95% CI: 0.07–0.62) p = 0.005].ConclusionEffective tricuspid edge-to-edge repair is associated with improved renal function and reduced heart failure hospitalization. In patients without renal improvement at 3-months follow-up, residual tricuspid regurgitation should be reevaluated for reintervention.

OBJECTIVE:The aim of this study was to investigate the influence of systolic blood pressure (SBP) values on admission on the outcome of mitral transcatheter edge-to-edge repair (M-TEER). METHODOLOGY:We included all patients who underwent interventional MV repair in our institution between January 2010 and October 2020. All data are obtained from the MiTra ULM registry. Based on SBP values measured on admission, all patients were divided into four groups: < 120, 120-129, 130-139, and ≥ 140 mmHg. RESULTS:Eight hundred and fifty-eight patients were included in this study. There were no major differences in demographic and clinical characteristics between the four observed groups. The patients with SBP on admission ≥ 140 mmHg had the lowest prevalence of functional MR and the highest LVEF. Higher SBP at admission (HR 0.74, 95% CI: 0.63-0.87) and preprocedural LVEF values (HR 0.99, 95% CI: 0.97-0.99) were predictors of lower 1-year mortality but did not impact 1-year hospitalization rate or MACE in the whole study population. When patients were separated into two groups according to the mechanisms of MR (functional and structural), the results showed that higher SBP on admission and better preprocedural LVEF were associated with significantly lower 1-year CV mortality in both groups of patients, with functional and structural MR. Higher SBP at admission was also associated with lower 1-year CV mortality (HR 0.73, 95% CI: 0.55-0.96) in patients with preserved ejection fraction (LVEF > 50%), but not with 1-year rehospitalization and MACE. CONCLUSION:Higher SBP on admission (> 140 mmHg) is an independent predictor of a better 1-year outcome in patients treated with M-TEER. The effect of higher SBP on outcome after M-TEER should be further investigated.

Background Mitral transcatheter edge-to-edge repair (M-TEER) is an established treatment for functional mitral regurgitation (FMR) associated with a risk of creating iatrogenic stenosis. Objectives To investigate the impact of the P10 and its larger spacer compared to the narrower Ace and its smaller spacer on reduction of mitral valve orifice area (MVOA) during M-TEER. Methods Consecutive patients undergoing M-TEER for treatment of severe FMR were screened retrospectively. Patients with a single PASCAL device implantation within the central segments of the MV leaflets, non-complex anatomy, and baseline MVOA ≥ 3.5cm 2 were selected. Intraprocedural transesophageal echocardiography was used to compare MVOA reduction with 3D multiplanar reconstruction and direct planimetry. Device selection did not follow a prespecified MVOA threshold. Results Seventy-two patients (81.0 years, IQR {74.3–85.0}) were included. In 32 patients, the P10 was implanted (44.4%). MR severity ( p = 0.66), MR reduction ( p = 0.73), and body surface area ( p = 0.56) were comparable. Baseline MVOA tended to be smaller in P10 patients with the larger spacer (5.0 ± 1.1 vs. 5.4 ± 1.3cm 2 , p = 0.18), however, residual MVOA was larger in these patients (2.7 ± 0.7 vs. 2.3 ± 0.6cm 2 , p = 0.03). Accordingly, relative MVOA reduction was significantly less in P10 patients (− 45.9 ± 7.6 vs. − 56.3 ± 7.0%, p < 0.01). Indirect annuloplasty was more pronounced in Ace patients whereas mean transmitral gradients were similar. Conclusion In FMR patients with non-complex anatomy, the larger spacer of the P10 maintains greater MVOA with similar MR reduction. Hence, the use of the PASCAL Ace device in patients with small MVOAs might correlate with a risk of both clinically relevant orifice reduction and even iatrogenic stenosis. Graphical Abstract Seventy-two patients treated for functional mitral regurgitation (FMR) with the narrower PASCAL Ace featuring a smaller spacer ( n = 40) or the broader P10 with a larger spacer ( n = 32) were included in this study. Using 3D TEE and multiplanar reconstruction for direct planimetry, mitral valve orifice areas (MVOA) were measured before and after device implantation. Only patients with central device positioning were included. The dimensions of the PASCAL device platform are shown as well. Note the larger space and broader design of the P10 compared to the PASCAL Ace. The difference in MVOA reduction amounted to 10%, which translates into roughly 0.5 cm 2 based on an average MV found in this study.

Background Transcatheter edge-to-edge mitral valve repair (M-TEER) is often performed in general anesthesia, and postprocedural monitoring is usually warranted on an intensive or intermediate care unit (ICU/IMC). We evaluated the implications of a dedicated valve unit (VU) instead of an ICU/IMC for monitoring after M-TEER. Methods and results In total, 624 patients were retrospectively analyzed. A total of 312 patients were primarily transferred to either ICU or IMC following M-TEER, and 312 patients were scheduled for the VU in the absence of indications for ICU/IMC treatment. Hospital stay was significantly shorter in VU patients (median 6.0 days (interquartile range (IQR) 5.0 – 8.0) vs. 7.0 days (IQR 6.0 – 10.0), p < 0.001) and their risk for infections (2.9 vs. 7.7%, p = 0.008) and delirium (0.6 vs. 2.6%, p = 0.056) was substantially lower compared to ICU/IMC patients. In-hospital mortality was similar in both groups (0.6% vs. 1.3%, p = 0.41). Fifty patients (16.0%) in the VU group had to cross over to unplanned ICU/IMC admission. The most frequent indication was prolonged need for catecholamines (52.0%). Patients with ICU/IMC crossover had more advanced stages of heart failure (LV-EF < 30% in 36.0 vs. 16.0%, p = 0.001; severe concomitant tricuspid regurgitation in 48.0 vs. 27.8%, p = 0.005) and an LV-EF < 30% was independently associated with unplanned ICU/IMC admission. Conclusions Following M-TEER postprocedural monitoring on a VU instead of an ICU/IMC is safe, reduces complications, and spares ICU capacities. Patients with advanced heart failure have a higher risk for unplanned ICU/IMC treatment after M-TEER. Graphical abstract Valve unit instead of intensive or intermediate care unit admission following transcatheter edge-to-edge mitral valve repair is safe and reduces postprocedural complications.

AbstractAimsPrevalence of mitral regurgitation (MR) and comorbidity burden rise with age. Mitral valve transcatheter edge‐to‐edge repair (M‐TEER) is increasingly performed in elderly patients, but only limited data are available for this specific subgroup. In this study, outcomes of octogenarians and nonagenarians undergoing M‐TEER were analysed using a large real‐world dataset.MethodsThis retrospective study included consecutive patients undergoing M‐TEER at the Ulm University Heart Center between January 2010 and December 2021. The cohort was divided into an elderly group and a younger group based on the cohorts' median age. Group differences regarding 1 and 3 year mortality and heart failure hospitalization rates were assessed using Kaplan–Meier survival analysis and Cox proportional hazard models.ResultsA total of 1118 patients [median age 79 (inter‐quartile range 74–83) years; 42% female] were included and divided into 513 elderly (≥80 years) and 605 younger (<80 years) patients. Primary MR was more frequent in the elderly group (56% vs. 27%, P < 0.001). Pre‐procedural and post‐procedural MR grades were comparable between groups (pre‐procedural MR grade 4: 69% in the elderly group vs. 71% in the younger group, P = 0.67; post‐procedural MR grade 1: 60% in the elderly group vs. 58% in the younger group, P = 0.77) as well as in‐hospital mortality rates (0.2% vs. 0.3%, P = 0.66). Three‐year heart failure hospitalization rates did not differ significantly between both groups (30.7% in the older age cohort vs. 36.0% in the younger cohort, P = 0.191). While 1 year all‐cause mortality rates were comparable (18% vs. 16.4%, P = 0.577), 3 year all‐cause mortality was significantly higher in the elderly [43.1% vs. 33.0%; hazard ratio (HR) 1.29 (95% confidence interval 1.02–1.65), P = 0.035]. Pre‐procedural N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) ≥3402 pg/mL [HR 2.29 (95% CI 1.34–3.90), P = 0.002], pre‐interventional MR grade [HR 1.79 (95% CI 1.01–3.17), P = 0.045] and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II [HR 1.06 (95% CI 1.03–1.08), P < 0.001] were identified as independent predictors of 3 year mortality in the elderly.ConclusionsM‐TEER displays a safe and effective treatment option for elderly patients with symptomatic MR, offering symptom relief and comparable 1 year outcomes to younger patients. Elderly patients with elevated EuroSCORE II and advanced heart failure might benefit from additional care to further reduce 3 year mortality.

(1) Objective: We aimed to assess whether the candidate profile, the long-term outcomes and the predictors for long-term mortality after transcatheter edge-to-edge mitral valve repair (M-TEER) have changed over the last decade; (2) Methods: Long-term follow-up data (median time of 1202 days) including mortality, MACCE and functional status were available for 677 consecutive patients enrolled in the prospective MiTra Ulm registry from January 2010 to April 2019. The initial 340 patients treated in our institution before January 2016 were compared with the following 337 patients; (3) Results: Patients treated after 2016 showed significantly less ventricular dilatation (left ventricular end-systolic diameter of 43 ± 13 mm vs. 49 ± 16 mm, p < 0.007), lower systolic pulmonary pressures (50 ± 15 mmHg vs. 57 ± 21 mmHg, p = 0.01) and a lower prevalence of severe tricuspid regurgitation (27.2% vs. 47.3%, p < 0.001) at baseline than patients treated before 2016. Compared to the cohort treated before 2016, patients treated afterwards showed a significantly lower all-cause 3-year mortality (29.4% vs. 43.8%, p < 0.001) and lower MACCE (38.6% vs. 54.1%, p < 0.001), without differences for MR etiology. While severe tricuspid regurgitation and NYHA class IV remained independently associated with an increased long-term mortality over the last decade, severe left ventricular dilatation (hazard ratio, HR 2.12, p = 0.047) and severe pulmonary hypertension (HR 2.18, p = 0.047) were predictors of long-term mortality only in patients treated before 2016. (4) Conclusions: The M-TEER candidates are currently treated earlier in the course of disease and benefit significantly in terms of a better long-term survival than patients treated at the beginning of the M-TEER era.