TY - JOUR
T1 - Association of transcatheter edge-To-edge repair with improved survival in older patients with severe, symptomatic degenerative mitral regurgitation
AU - Benfari, Giovanni
AU - Sorajja, Paul
AU - Pedrazzini, Giovanni
AU - Taramasso, Maurizio
AU - Gavazzoni, Mara
AU - Biasco, Luigi
AU - Essayagh, Benjamin
AU - Grigioni, Francesco
AU - Bae, Richard
AU - Tribouilloy, Christophe
AU - Vanoverschelde, Jean Louis
AU - Michelena, Hector
AU - Bapat, Vinayak N.
AU - Vancraynest, David
AU - Klersy, Catherine
AU - Curti, Moreno
AU - Thapa, Prabin
AU - Enriquez-Sarano, Maurice
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of European Society of Cardiology. All rights reserved.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background: Randomized clinical trials demonstrated transcatheter edge-To-edge repair (TEER) efficacy in improving outcome vs. medical management for functional mitral regurgitation, but limited randomized data are available for the treatment of degenerative mitral regurgitation (DMR). We aimed to compare the outcome of older patients treated with TEER vs. unoperated DMR. Methods and results: Registries including consecutive patients ≥65 years with symptomatic severe DMR treated with TEER (MitraSwiss and Minneapolis Heart Institute registries) or unoperated (MIDA registry) were analysed. Survival was compared overall and after matching for age, sex, EuroSCORE II, and ejection fraction. The study included 1187 patients (872 treated with TEER and 315 unoperated). During 24 ± 17 months of follow-up, 430 patients died, 18 ± 1% at 1 year and 50 ± 2% at 4 years. Patients undergoing TEER had similar age (82 ± 6 vs. 82 ± 7 years) and sex to unoperated patients, but higher surgical risk/comorbidity (EuroSCORE II 3.98 ± 4.28% vs. 2.77 ± 2.46%), more symptoms, and atrial fibrillation (P < 0.0001). Transcatheter edge-To-edge repair was associated with lower mortality accounting for age, sex, EuroSCORE II, New York Heart Association class, atrial fibrillation, and ejection fraction [hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.37-0.58; P < 0.0001]. After propensity matching (247 pairs of patients), TEER consistently showed better survival compared with unoperated patients (49 ± 6% vs. 37 ± 3% at 4 years, P < 0.0001) even in comprehensive multivariable analysis (HR: 0.60, 95% CI: 0.40-0.91; P = 0.03). Procedural failure was infrequent but post-procedural mitral regurgitation, remaining moderate-To-severe in 66 (7.6%) patients, was associated with excess mortality vs.Trivial residual regurgitation (30 ± 6% vs. 11 ± 1% at 1 year, P < 0.0001). Conclusion: Amongst older patients with severe symptomatic DMR at high surgical risk, mitral TEER was associated with higher survival vs. unoperated patients. Successful control of mitral regurgitation was key to survival improvement with mitral TEER, which should be actively considered in patients deemed inoperable.
AB - Background: Randomized clinical trials demonstrated transcatheter edge-To-edge repair (TEER) efficacy in improving outcome vs. medical management for functional mitral regurgitation, but limited randomized data are available for the treatment of degenerative mitral regurgitation (DMR). We aimed to compare the outcome of older patients treated with TEER vs. unoperated DMR. Methods and results: Registries including consecutive patients ≥65 years with symptomatic severe DMR treated with TEER (MitraSwiss and Minneapolis Heart Institute registries) or unoperated (MIDA registry) were analysed. Survival was compared overall and after matching for age, sex, EuroSCORE II, and ejection fraction. The study included 1187 patients (872 treated with TEER and 315 unoperated). During 24 ± 17 months of follow-up, 430 patients died, 18 ± 1% at 1 year and 50 ± 2% at 4 years. Patients undergoing TEER had similar age (82 ± 6 vs. 82 ± 7 years) and sex to unoperated patients, but higher surgical risk/comorbidity (EuroSCORE II 3.98 ± 4.28% vs. 2.77 ± 2.46%), more symptoms, and atrial fibrillation (P < 0.0001). Transcatheter edge-To-edge repair was associated with lower mortality accounting for age, sex, EuroSCORE II, New York Heart Association class, atrial fibrillation, and ejection fraction [hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.37-0.58; P < 0.0001]. After propensity matching (247 pairs of patients), TEER consistently showed better survival compared with unoperated patients (49 ± 6% vs. 37 ± 3% at 4 years, P < 0.0001) even in comprehensive multivariable analysis (HR: 0.60, 95% CI: 0.40-0.91; P = 0.03). Procedural failure was infrequent but post-procedural mitral regurgitation, remaining moderate-To-severe in 66 (7.6%) patients, was associated with excess mortality vs.Trivial residual regurgitation (30 ± 6% vs. 11 ± 1% at 1 year, P < 0.0001). Conclusion: Amongst older patients with severe symptomatic DMR at high surgical risk, mitral TEER was associated with higher survival vs. unoperated patients. Successful control of mitral regurgitation was key to survival improvement with mitral TEER, which should be actively considered in patients deemed inoperable.
KW - Degenerative mitral regurgitation
KW - Survival
KW - Transcatheter edge-To-edge repair
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U2 - 10.1093/eurheartj/ehab910
DO - 10.1093/eurheartj/ehab910
M3 - Article
C2 - 35090000
AN - SCOPUS:85129781742
SN - 0195-668X
VL - 43
SP - 1626
EP - 1635
JO - European heart journal
JF - European heart journal
IS - 17
ER -