M-TEER Shown to Improve Symptoms and QoL in Patients With Mitral Annular Calcification

April 24, 2026—Patients with mitral annular calcification (MAC) who undergo mitral transcatheter edge-to-edge repair (M-TEER) experienced similar reductions in mitral regurgitation (MR) and improvement in quality of life compared to those seen in patients without calcification. These findings from the EXPANDed study were presented by Karim Al-Azizi, MD, at SCAI 2026.

According to the SCAI press release, the EXPANDed study analyzed data from the EXPAND and EXPAND G4 studies, which included patients who underwent M-TEER with the MitraClip G3 or G4 systems (Abbott) at 91 sites across the United States, Europe, Canada, the Middle East, and Japan between 2018 and 2022. Of 1,907 patients, 327 had MAC.

As noted by SCAI, these patients were older, had greater surgical risk, a higher prevalence of primary MR, and were more likely to be female. In addition, half of the patients in both groups had been hospitalized for heart failure within the previous year.

As outlined in the SCAI press release, the analysis findings included the following for the group with MAC versus the group without calcification (no MAC):

• Acute procedural success was 92% in the MAC group and 96% in the no-MAC group.
• All-cause mortality was higher in the MAC group at 30 days (3.4% vs 1.7%; P = .04) and at 1 year (18.3% vs 12.1%; P = .003).
• Heart failure hospitalization at 1 year was higher in the MAC group (24.2% vs 16.4%; P = .001).
• Through 1 year, there were no safety concerns with low rates of replacement, single-leaflet device attachment, myocardial infarction, and stroke in both groups.
• At 1 year, the reduction in MR was similar with 87.9% of MAC and 91.3% of no-MAC patients having MR ≤ 1+.
• Quality of life also improved significantly in both groups and was sustained through 1 year, with 81% of patients with mild to no symptoms at normal activity (New York Heart Association, class I/II).
• Large gains were seen in Kansas City Cardiomyopathy Questionnaire–Overall Summary scores with 21.8 ± 26.3 for MAC patients and 19.0 ± 24.5 for no-MAC patients.

“We know that the presence of MAC can complicate mitral valve disease,” commented Dr. Al-Azizi in the SCAI press release. “However, this first large real-world study shows that the MitraClip procedure is a safe and effective option for patients with severe symptoms, leading to significant reductions in mitral regurgitation and meaningful improvements in quality of life regardless of the presence of MAC.”

Dr. Al-Azizi continued, “Differences observed in 1-year mortality and heart failure hospitalizations likely reflect the greater burden and complexity of comorbidities among patients with MAC compared with those without calcification.”