Transcatheter Mitral Valve Interventions: Clinical Efficacy and Safety Trends (2017–2024)

Background: Transcatheter mitral valve interventions (TMVI) have transformed the therapeutic landscape for patients with mitral regurgitation (MR), particularly those deemed high-risk or inoperable for conventional surgery. Since 2017, rapid technological evolution has led to the emergence and clinical adoption of transcatheter edge-to-edge repair (TEER), transcatheter mitral valve replacement (TMVR), and hybrid approaches. As device platforms, operator experience, and patient selection criteria have evolved, evaluating longitudinal trends in efficacy and safety is essential to guide best practices and inform future innovation. Methods and Results: This systematic review and pooled analysis examined 42 multicenter studies and registries published between 2017 and 2024, encompassing over 18,000 patients undergoing TMVI for primary and secondary MR. Outcomes assessed included procedural success, 30-day and 1-year mortality, MR reduction, rehospitalization for heart failure, and major adverse cardiovascular events (MACE). TEER with MitraClip and PASCAL demonstrated high procedural success rates (>94%) and significant symptomatic improvement with sustained MR reduction in functional MR populations. TMVR devices showed promise in anatomically complex cases, particularly for patients with severe annular calcification or failed surgical repairs, albeit with higher early mortality and left ventricular outflow tract obstruction risk. Overall, complication rates—including bleeding, stroke, and device embolization—declined over time, reflecting enhanced imaging, procedural planning, and device refinement. Subgroup analyses revealed improved outcomes with newer-generation devices and in patients treated at high-volume centers. Conclusion: Transcatheter mitral valve therapies have matured into safe and effective alternatives for a growing spectrum of MR patients, with steadily improving clinical outcomes from 2017 to 2024. Continued advances in device technology, patient selection algorithms, and postprocedural management will further optimize TMVI performance.