Degenerative Mitral Regurgitation After Nonmitral Cardiac Surgery

MitraClip Versus Surgical Reconstruction

Lucman A. Anwer, Joseph A. Dearani, Richard C. Daly, John M. Stulak, Hartzell V Schaff, Anita Nguyen, Hadi Toeg, Yan Topilsky, Hector I Michelena, Mackram Eleid, Simon Maltais

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Surgical mitral valve repair is the conventional treatment for severe degenerative mitral regurgitation (MR). MitraClip therapy has emerged as a viable option in high-risk surgical patients. We sought to compare conventional surgery to MitraClip therapy in patients with severe degenerative mitral valve prolapse (MVP) and previous cardiac interventions. Methods: From January 2012 to May 2016, 131 patients with previous cardiac surgery and subsequent intervention for degenerative MVP were included in this analysis: 75 (57.3%) underwent surgical repair and 56 (42.7%) underwent MitraClip placement. Follow-up was available in all early survivors at median of 11 (interquartile range, 0 to 32) months for surgery and 11 (interquartile range, 3 to 21) months for MitraClip patients. Results: MitraClip patients were older (75.7 ± 8.6 years of age versus 68.6 ± 13.1 of age; p < 0.001), and had higher Society of Thoracic Surgeons risk scores (5.8 ± 2.4 versus 2.7 ± 2.3; p < 0.001). Median length-of-stay was 7 (interquartile range, 5 to 11) days for surgery and 2 (interquartile range, 2 to 4) days for MitraClip patients (p < 0.001), but 30-day mortality was comparable between the 2 groups (2.7% versus 3.6%; p = 0.77). Recurrent MR (moderate or severe) was significantly higher for MitraClip patients, both at discharge (43.1% versus 5.4%; p < 0.001) and at 1-year follow-up (66.7% versus 33.3%; p = 0.02). At 1 year postintervention, freedom from mitral reintervention was significantly higher for surgical patients (100.0% versus 87.5%; p = 0.006). Conclusions: In patients with previous cardiac interventions and severe degenerative MVP, a repeat conventional surgery is safe and durable. Percutaneous MitraClip repair is effective but associated with higher risk of residual MR, and should only be considered in selected patients. Careful patient selection using a heart team approach is recommended.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Mitral Valve Insufficiency
Thoracic Surgery
Mitral Valve Prolapse
Ambulatory Surgical Procedures
Mitral Valve
Reoperation
Surgical Instruments
Patient Selection
Survivors
Length of Stay
Therapeutics
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Degenerative Mitral Regurgitation After Nonmitral Cardiac Surgery : MitraClip Versus Surgical Reconstruction. / Anwer, Lucman A.; Dearani, Joseph A.; Daly, Richard C.; Stulak, John M.; Schaff, Hartzell V; Nguyen, Anita; Toeg, Hadi; Topilsky, Yan; Michelena, Hector I; Eleid, Mackram; Maltais, Simon.

In: Annals of Thoracic Surgery, 01.01.2019.

Research output: Contribution to journalArticle

@article{f670bf09df8b475bbcd851dfdb49dfa8,
title = "Degenerative Mitral Regurgitation After Nonmitral Cardiac Surgery: MitraClip Versus Surgical Reconstruction",
abstract = "Background: Surgical mitral valve repair is the conventional treatment for severe degenerative mitral regurgitation (MR). MitraClip therapy has emerged as a viable option in high-risk surgical patients. We sought to compare conventional surgery to MitraClip therapy in patients with severe degenerative mitral valve prolapse (MVP) and previous cardiac interventions. Methods: From January 2012 to May 2016, 131 patients with previous cardiac surgery and subsequent intervention for degenerative MVP were included in this analysis: 75 (57.3{\%}) underwent surgical repair and 56 (42.7{\%}) underwent MitraClip placement. Follow-up was available in all early survivors at median of 11 (interquartile range, 0 to 32) months for surgery and 11 (interquartile range, 3 to 21) months for MitraClip patients. Results: MitraClip patients were older (75.7 ± 8.6 years of age versus 68.6 ± 13.1 of age; p < 0.001), and had higher Society of Thoracic Surgeons risk scores (5.8 ± 2.4 versus 2.7 ± 2.3; p < 0.001). Median length-of-stay was 7 (interquartile range, 5 to 11) days for surgery and 2 (interquartile range, 2 to 4) days for MitraClip patients (p < 0.001), but 30-day mortality was comparable between the 2 groups (2.7{\%} versus 3.6{\%}; p = 0.77). Recurrent MR (moderate or severe) was significantly higher for MitraClip patients, both at discharge (43.1{\%} versus 5.4{\%}; p < 0.001) and at 1-year follow-up (66.7{\%} versus 33.3{\%}; p = 0.02). At 1 year postintervention, freedom from mitral reintervention was significantly higher for surgical patients (100.0{\%} versus 87.5{\%}; p = 0.006). Conclusions: In patients with previous cardiac interventions and severe degenerative MVP, a repeat conventional surgery is safe and durable. Percutaneous MitraClip repair is effective but associated with higher risk of residual MR, and should only be considered in selected patients. Careful patient selection using a heart team approach is recommended.",
author = "Anwer, {Lucman A.} and Dearani, {Joseph A.} and Daly, {Richard C.} and Stulak, {John M.} and Schaff, {Hartzell V} and Anita Nguyen and Hadi Toeg and Yan Topilsky and Michelena, {Hector I} and Mackram Eleid and Simon Maltais",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.athoracsur.2018.09.036",
language = "English (US)",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",

}

TY - JOUR

T1 - Degenerative Mitral Regurgitation After Nonmitral Cardiac Surgery

T2 - MitraClip Versus Surgical Reconstruction

AU - Anwer, Lucman A.

AU - Dearani, Joseph A.

AU - Daly, Richard C.

AU - Stulak, John M.

AU - Schaff, Hartzell V

AU - Nguyen, Anita

AU - Toeg, Hadi

AU - Topilsky, Yan

AU - Michelena, Hector I

AU - Eleid, Mackram

AU - Maltais, Simon

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Surgical mitral valve repair is the conventional treatment for severe degenerative mitral regurgitation (MR). MitraClip therapy has emerged as a viable option in high-risk surgical patients. We sought to compare conventional surgery to MitraClip therapy in patients with severe degenerative mitral valve prolapse (MVP) and previous cardiac interventions. Methods: From January 2012 to May 2016, 131 patients with previous cardiac surgery and subsequent intervention for degenerative MVP were included in this analysis: 75 (57.3%) underwent surgical repair and 56 (42.7%) underwent MitraClip placement. Follow-up was available in all early survivors at median of 11 (interquartile range, 0 to 32) months for surgery and 11 (interquartile range, 3 to 21) months for MitraClip patients. Results: MitraClip patients were older (75.7 ± 8.6 years of age versus 68.6 ± 13.1 of age; p < 0.001), and had higher Society of Thoracic Surgeons risk scores (5.8 ± 2.4 versus 2.7 ± 2.3; p < 0.001). Median length-of-stay was 7 (interquartile range, 5 to 11) days for surgery and 2 (interquartile range, 2 to 4) days for MitraClip patients (p < 0.001), but 30-day mortality was comparable between the 2 groups (2.7% versus 3.6%; p = 0.77). Recurrent MR (moderate or severe) was significantly higher for MitraClip patients, both at discharge (43.1% versus 5.4%; p < 0.001) and at 1-year follow-up (66.7% versus 33.3%; p = 0.02). At 1 year postintervention, freedom from mitral reintervention was significantly higher for surgical patients (100.0% versus 87.5%; p = 0.006). Conclusions: In patients with previous cardiac interventions and severe degenerative MVP, a repeat conventional surgery is safe and durable. Percutaneous MitraClip repair is effective but associated with higher risk of residual MR, and should only be considered in selected patients. Careful patient selection using a heart team approach is recommended.

AB - Background: Surgical mitral valve repair is the conventional treatment for severe degenerative mitral regurgitation (MR). MitraClip therapy has emerged as a viable option in high-risk surgical patients. We sought to compare conventional surgery to MitraClip therapy in patients with severe degenerative mitral valve prolapse (MVP) and previous cardiac interventions. Methods: From January 2012 to May 2016, 131 patients with previous cardiac surgery and subsequent intervention for degenerative MVP were included in this analysis: 75 (57.3%) underwent surgical repair and 56 (42.7%) underwent MitraClip placement. Follow-up was available in all early survivors at median of 11 (interquartile range, 0 to 32) months for surgery and 11 (interquartile range, 3 to 21) months for MitraClip patients. Results: MitraClip patients were older (75.7 ± 8.6 years of age versus 68.6 ± 13.1 of age; p < 0.001), and had higher Society of Thoracic Surgeons risk scores (5.8 ± 2.4 versus 2.7 ± 2.3; p < 0.001). Median length-of-stay was 7 (interquartile range, 5 to 11) days for surgery and 2 (interquartile range, 2 to 4) days for MitraClip patients (p < 0.001), but 30-day mortality was comparable between the 2 groups (2.7% versus 3.6%; p = 0.77). Recurrent MR (moderate or severe) was significantly higher for MitraClip patients, both at discharge (43.1% versus 5.4%; p < 0.001) and at 1-year follow-up (66.7% versus 33.3%; p = 0.02). At 1 year postintervention, freedom from mitral reintervention was significantly higher for surgical patients (100.0% versus 87.5%; p = 0.006). Conclusions: In patients with previous cardiac interventions and severe degenerative MVP, a repeat conventional surgery is safe and durable. Percutaneous MitraClip repair is effective but associated with higher risk of residual MR, and should only be considered in selected patients. Careful patient selection using a heart team approach is recommended.

UR - http://www.scopus.com/inward/record.url?scp=85060913497&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060913497&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2018.09.036

DO - 10.1016/j.athoracsur.2018.09.036

M3 - Article

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

ER -