TRANScatheter edge-to-edge rePAir for SAM related mitral REgurgitation in patieNTs with HCM. The TRANSPARENT registry

Luca Testa; Luca Arzuffi; Antonio Popolo Rubbio; Nedy Brambilla; Francesco Maisano; Eustachio Agricola; Mony Shuvy; Antonio Mangieri; Carmelo Grasso; Azeem Latib; Ole De Backer; Ignacio J Amat Santos; Giuseppe Tarantini; Fausto Castriota; Tomás Benito-González; Luigi Biasco; Rodrigo Estévez-Loureiro; Leor Perl; Maurizio B Tusa; Francesco Bedogni

doi:10.1016/j.jcin.2025.10.013

TRANScatheter edge-to-edge rePAir for SAM related mitral REgurgitation in patieNTs with HCM. The TRANSPARENT registry

Luca Testa^*, Luca Arzuffi, Antonio Popolo Rubbio, Nedy Brambilla, Francesco Maisano, Eustachio Agricola, Mony Shuvy, Antonio Mangieri, Carmelo Grasso, Azeem Latib, Ole De Backer, Ignacio J Amat Santos, Giuseppe Tarantini, Fausto Castriota, Tomás Benito-González, Luigi Biasco, Rodrigo Estévez-Loureiro, Leor Perl, Maurizio B Tusa, Francesco Bedogni

^*Corresponding author for this work

Department of Cardiology

1 Citation (Scopus)

Abstract

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by left ventricular hypertrophy, left ventricle outflow tract obstruction (LVOTO), systolic anterior motion (SAM), and subsequent mitral regurgitation (MR). Although its risk/benefit profile remains unclear, transcatheter mitral edge-to-edge repair (M-TEER) may be beneficial for patients at high or prohibitive surgical risk.

OBJECTIVES: Evaluate the safety and efficacy of M-TEER in patients with obstructive HCM and moderate-to-severe or severe SAM-related MR.

METHODS: Retrospective, international, multicenter study including 35 symptomatic patients treated with M-TEER at 12 centers. MVARC definitions were applied. Echocardiographic and clinical outcomes were assessed at discharge, 30 days, 1 year, and last available follow-up.

RESULTS: MVARC technical, 30-day device and procedural success were achieved in 94%, 91% and 88% of the cases, respectively. MR <2 was achieved in 97% of patients. LVOT gradient decreased from 62.0 mmHg (IQR 35.5-92.0) to 16.0 mmHg (IQR 12.0-22.0), p<0.05, and the reduction persisted at a median follow-up of 523 days. NYHA class I/II increased from 31% to 88% at last follow-up. The composite outcome (all-cause death, admission for acute decompensated heart failure, M-TEER re-do, surgical mitral valve replacement) occurred in 26% of the cases, mainly driven by ADHF.

CONCLUSIONS: M-TEER appears to be a feasible and safe therapeutic option for anatomically suitable patients with obstructive HCM, LVOTO and SAM-related MR who are at high or prohibitive surgical risk. Larger scale data are warranted to further elucidate the role of M-TEER in this subset of patients.

Original language	English
Journal	JACC. Cardiovascular interventions
Volume	19
Issue number	5
Pages (from-to)	604-614
Number of pages	11
ISSN	1936-8798
DOIs	https://doi.org/10.1016/j.jcin.2025.10.013
Publication status	Published - 9 Mar 2026

Keywords

HCM
M-TEER
mitral regurgitation
systolic anterior motion

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10.1016/j.jcin.2025.10.013

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Testa, L., Arzuffi, L., Rubbio, A. P., Brambilla, N., Maisano, F., Agricola, E., Shuvy, M., Mangieri, A., Grasso, C., Latib, A., De Backer, O., Amat Santos, I. J., Tarantini, G., Castriota, F., Benito-González, T., Biasco, L., Estévez-Loureiro, R., Perl, L., Tusa, M. B., & Bedogni, F. (2026). TRANScatheter edge-to-edge rePAir for SAM related mitral REgurgitation in patieNTs with HCM. The TRANSPARENT registry. JACC. Cardiovascular interventions, 19(5), 604-614. https://doi.org/10.1016/j.jcin.2025.10.013

Testa, L, Arzuffi, L, Rubbio, AP, Brambilla, N, Maisano, F, Agricola, E, Shuvy, M, Mangieri, A, Grasso, C, Latib, A, De Backer, O, Amat Santos, IJ, Tarantini, G, Castriota, F, Benito-González, T, Biasco, L, Estévez-Loureiro, R, Perl, L, Tusa, MB & Bedogni, F 2026, 'TRANScatheter edge-to-edge rePAir for SAM related mitral REgurgitation in patieNTs with HCM. The TRANSPARENT registry', JACC. Cardiovascular interventions, vol. 19, no. 5, pp. 604-614. https://doi.org/10.1016/j.jcin.2025.10.013

@article{b48b92f56fee416aae63760847c6231e,

title = "TRANScatheter edge-to-edge rePAir for SAM related mitral REgurgitation in patieNTs with HCM. The TRANSPARENT registry",

abstract = "BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by left ventricular hypertrophy, left ventricle outflow tract obstruction (LVOTO), systolic anterior motion (SAM), and subsequent mitral regurgitation (MR). Although its risk/benefit profile remains unclear, transcatheter mitral edge-to-edge repair (M-TEER) may be beneficial for patients at high or prohibitive surgical risk.OBJECTIVES: Evaluate the safety and efficacy of M-TEER in patients with obstructive HCM and moderate-to-severe or severe SAM-related MR.METHODS: Retrospective, international, multicenter study including 35 symptomatic patients treated with M-TEER at 12 centers. MVARC definitions were applied. Echocardiographic and clinical outcomes were assessed at discharge, 30 days, 1 year, and last available follow-up.RESULTS: MVARC technical, 30-day device and procedural success were achieved in 94\%, 91\% and 88\% of the cases, respectively. MR <2 was achieved in 97\% of patients. LVOT gradient decreased from 62.0 mmHg (IQR 35.5-92.0) to 16.0 mmHg (IQR 12.0-22.0), p<0.05, and the reduction persisted at a median follow-up of 523 days. NYHA class I/II increased from 31\% to 88\% at last follow-up. The composite outcome (all-cause death, admission for acute decompensated heart failure, M-TEER re-do, surgical mitral valve replacement) occurred in 26\% of the cases, mainly driven by ADHF.CONCLUSIONS: M-TEER appears to be a feasible and safe therapeutic option for anatomically suitable patients with obstructive HCM, LVOTO and SAM-related MR who are at high or prohibitive surgical risk. Larger scale data are warranted to further elucidate the role of M-TEER in this subset of patients.",

keywords = "HCM, M-TEER, mitral regurgitation, systolic anterior motion",

author = "Luca Testa and Luca Arzuffi and Rubbio, \{Antonio Popolo\} and Nedy Brambilla and Francesco Maisano and Eustachio Agricola and Mony Shuvy and Antonio Mangieri and Carmelo Grasso and Azeem Latib and \{De Backer\}, Ole and \{Amat Santos\}, \{Ignacio J\} and Giuseppe Tarantini and Fausto Castriota and Tom{\'a}s Benito-Gonz{\'a}lez and Luigi Biasco and Rodrigo Est{\'e}vez-Loureiro and Leor Perl and Tusa, \{Maurizio B\} and Francesco Bedogni",

note = "Copyright {\textcopyright} 2025. Published by Elsevier Inc.",

year = "2026",

month = mar,

day = "9",

doi = "10.1016/j.jcin.2025.10.013",

language = "English",

volume = "19",

pages = "604--614",

journal = "JACC. Cardiovascular interventions",

issn = "1936-8798",

publisher = "Elsevier Inc.",

number = "5",

}

TY - JOUR

T1 - TRANScatheter edge-to-edge rePAir for SAM related mitral REgurgitation in patieNTs with HCM. The TRANSPARENT registry

AU - Testa, Luca

AU - Arzuffi, Luca

AU - Rubbio, Antonio Popolo

AU - Brambilla, Nedy

AU - Maisano, Francesco

AU - Agricola, Eustachio

AU - Shuvy, Mony

AU - Mangieri, Antonio

AU - Grasso, Carmelo

AU - Latib, Azeem

AU - De Backer, Ole

AU - Amat Santos, Ignacio J

AU - Tarantini, Giuseppe

AU - Castriota, Fausto

AU - Benito-González, Tomás

AU - Biasco, Luigi

AU - Estévez-Loureiro, Rodrigo

AU - Perl, Leor

AU - Tusa, Maurizio B

AU - Bedogni, Francesco

PY - 2026/3/9

Y1 - 2026/3/9

N2 - BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by left ventricular hypertrophy, left ventricle outflow tract obstruction (LVOTO), systolic anterior motion (SAM), and subsequent mitral regurgitation (MR). Although its risk/benefit profile remains unclear, transcatheter mitral edge-to-edge repair (M-TEER) may be beneficial for patients at high or prohibitive surgical risk.OBJECTIVES: Evaluate the safety and efficacy of M-TEER in patients with obstructive HCM and moderate-to-severe or severe SAM-related MR.METHODS: Retrospective, international, multicenter study including 35 symptomatic patients treated with M-TEER at 12 centers. MVARC definitions were applied. Echocardiographic and clinical outcomes were assessed at discharge, 30 days, 1 year, and last available follow-up.RESULTS: MVARC technical, 30-day device and procedural success were achieved in 94%, 91% and 88% of the cases, respectively. MR <2 was achieved in 97% of patients. LVOT gradient decreased from 62.0 mmHg (IQR 35.5-92.0) to 16.0 mmHg (IQR 12.0-22.0), p<0.05, and the reduction persisted at a median follow-up of 523 days. NYHA class I/II increased from 31% to 88% at last follow-up. The composite outcome (all-cause death, admission for acute decompensated heart failure, M-TEER re-do, surgical mitral valve replacement) occurred in 26% of the cases, mainly driven by ADHF.CONCLUSIONS: M-TEER appears to be a feasible and safe therapeutic option for anatomically suitable patients with obstructive HCM, LVOTO and SAM-related MR who are at high or prohibitive surgical risk. Larger scale data are warranted to further elucidate the role of M-TEER in this subset of patients.

AB - BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by left ventricular hypertrophy, left ventricle outflow tract obstruction (LVOTO), systolic anterior motion (SAM), and subsequent mitral regurgitation (MR). Although its risk/benefit profile remains unclear, transcatheter mitral edge-to-edge repair (M-TEER) may be beneficial for patients at high or prohibitive surgical risk.OBJECTIVES: Evaluate the safety and efficacy of M-TEER in patients with obstructive HCM and moderate-to-severe or severe SAM-related MR.METHODS: Retrospective, international, multicenter study including 35 symptomatic patients treated with M-TEER at 12 centers. MVARC definitions were applied. Echocardiographic and clinical outcomes were assessed at discharge, 30 days, 1 year, and last available follow-up.RESULTS: MVARC technical, 30-day device and procedural success were achieved in 94%, 91% and 88% of the cases, respectively. MR <2 was achieved in 97% of patients. LVOT gradient decreased from 62.0 mmHg (IQR 35.5-92.0) to 16.0 mmHg (IQR 12.0-22.0), p<0.05, and the reduction persisted at a median follow-up of 523 days. NYHA class I/II increased from 31% to 88% at last follow-up. The composite outcome (all-cause death, admission for acute decompensated heart failure, M-TEER re-do, surgical mitral valve replacement) occurred in 26% of the cases, mainly driven by ADHF.CONCLUSIONS: M-TEER appears to be a feasible and safe therapeutic option for anatomically suitable patients with obstructive HCM, LVOTO and SAM-related MR who are at high or prohibitive surgical risk. Larger scale data are warranted to further elucidate the role of M-TEER in this subset of patients.

KW - HCM

KW - M-TEER

KW - mitral regurgitation

KW - systolic anterior motion

UR - https://www.scopus.com/pages/publications/105031289648

U2 - 10.1016/j.jcin.2025.10.013

DO - 10.1016/j.jcin.2025.10.013

M3 - Journal article

C2 - 41146483

SN - 1936-8798

VL - 19

SP - 604

EP - 614

JO - JACC. Cardiovascular interventions

JF - JACC. Cardiovascular interventions

IS - 5

ER -

TRANScatheter edge-to-edge rePAir for SAM related mitral REgurgitation in patieNTs with HCM. The TRANSPARENT registry

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