TY - JOUR
T1 - Transcatheter Versus Surgical Valve Repair in Patients with Severe Mitral Regurgitation
AU - Koschutnik, Matthias
AU - Dannenberg, Varius
AU - Donà, Carolina
AU - Nitsche, Christian
AU - Kammerlander, Andreas A
AU - Koschatko, Sophia
AU - Zimpfer, Daniel
AU - Hülsmann, Martin
AU - Aschauer, Stefan
AU - Schneider, Matthias
AU - Bartko, Philipp E
AU - Goliasch, Georg
AU - Hengstenberg, Christian
AU - Mascherbauer, Julia
N1 - Funding Information:
Conflicts of Interest: V.D. received consulting fees from Abbott (modest), and educational grants from Edwards Lifesciences (modest). J.M. received proctor fees from Abbott (modest), consulting fees from Edwards Lifesciences (modest), Boston Scientific (modest), Shockwave Medical (modest), and educational grants from Edwards Lifesciences (modest). The remaining authors declare no conflict of interest.
Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2022/1/11
Y1 - 2022/1/11
N2 - 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.
AB - 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.
KW - Mitral regurgitation
KW - Mitral valve
KW - Outcome
KW - Surgical MV treatment
KW - TMVR
UR - http://www.scopus.com/inward/record.url?scp=85123220835&partnerID=8YFLogxK
U2 - 10.3390/jpm12010090
DO - 10.3390/jpm12010090
M3 - Journal article
C2 - 35055405
SN - 2075-4426
VL - 12
JO - Journal of Personalized Medicine
JF - Journal of Personalized Medicine
IS - 1
M1 - 90
ER -