Transcatheter Versus Surgical Valve Repair in Patients with Severe Mitral Regurgitation

Matthias Koschutnik, Varius Dannenberg, Carolina Donà, Christian Nitsche, Andreas A Kammerlander, Sophia Koschatko, Daniel Zimpfer, Martin Hülsmann, Stefan Aschauer, Matthias Schneider, Philipp E Bartko, Georg Goliasch, Christian Hengstenberg, Julia Mascherbauer

Research output: Journal article (peer-reviewed)Journal article

2 Citations (Scopus)


BACKGROUND: Transcatheter edge-to-edge mitral valve repair (TMVR) is increasingly performed. However, its efficacy in comparison with surgical MV treatment (SMV) is unknown.

METHODS: Consecutive patients with severe mitral regurgitation (MR) undergoing TMVR (68% functional, 32% degenerative) or SMV (9% functional, 91% degenerative) were enrolled. To account for differences in baseline characteristics, propensity score matching was performed, including age, EuroSCORE-II, left ventricular ejection fraction, and NT-proBNP. A composite of heart failure (HF) hospitalization/death served as primary endpoint. Kaplan-Meier curves and Cox-regression analyses were used to investigate associations between baseline, imaging, and procedural parameters and outcome.

RESULTS: Between July 2017 and April 2020, 245 patients were enrolled, of whom 102 patients could be adequately matched (73 y/o, 61% females, EuroSCORE-II: 5.7%, p > 0.05 for all). Despite matching, TMVR patients had more co-morbidities at baseline (higher rates of prior myocardial infarction, coronary revascularization, pacemakers/defibrillators, and diabetes mellitus, p < 0.009 for all). Patients were followed for 28.3 ± 27.2 months, during which 27 events (17 deaths, 10 HF hospitalizations) occurred. Postprocedural MR reduction (MR grade <2: TMVR vs. SMV: 88% vs. 94%, p = 0.487) and freedom from HF hospitalization/death (log-rank: p = 0.811) were similar at 2 years. On multivariable Cox analysis, EuroSCORE-II (adj.HR 1.07 [95%CI: 1.00-1.13], p = 0.027) and residual MR (adj.HR 1.85 [95%CI: 1.17-2.92], p = 0.009) remained significantly associated with outcome.

CONCLUSIONS: In this propensity-matched, all-comers cohort, two-year outcomes after TMVR versus SMV were similar. Given the reported favorable long-term durability of TMVR, the interventional approach emerges as a valuable alternative for a substantial number of patients with functional and degenerative MR.

Original languageEnglish
Article number90
JournalJournal of Personalized Medicine
Issue number1
Publication statusPublished - 11 Jan 2022


  • Mitral regurgitation
  • Mitral valve
  • Outcome
  • Surgical MV treatment
  • TMVR

ASJC Scopus subject areas

  • Medicine (miscellaneous)


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