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Transcatheter MV Repair for Degenerative Mitral Regurgitation
Quick Takes
- The safety profile of transcatheter mitral valve repair (TMVr) was excellent, despite advanced age and presence of significant comorbidities.
- Successful TMVr compared with those with unsuccessful repair, had better survival and lower hospitalization and MV reintervention rates at 1 year.
- Given the inherent limitations of this observational study, prospective randomized clinical trials of surgery vs. TMVr are needed to guide the optimal treatment of patients with degenerative MR.
Study Questions:
What are the outcomes of transcatheter mitral valve repair (TMVr) for isolated degenerative mitral regurgitation (MR) in a real-world setting?
Methods:
The investigators conducted a cohort study of consecutive patients in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies (STS/ACC TVT) Registry who underwent nonemergent TMVr for degenerative MR in the United States from 2014–2022. The primary endpoint was MR success, defined as moderate or less residual MR and a mean mitral gradient of <10 mm Hg. Clinical outcomes were evaluated based on the degree of residual MR (mild or less MR or moderate MR) and mitral valve (MV) gradients (≤5 mm Hg or >5 to <10 mm Hg). A multivariate logistic regression model was generated to assess the association between prespecified medical history and 30-day MR success.
Results:
A total of 19,088 patients with isolated moderate to severe or severe degenerative MR who underwent TMVr were analyzed (median age, 82 years; 48% women; median Society of Thoracic Surgeons predicted risk of mortality with surgical MV repair, 4.6%). MR success was achieved in 88.9% of patients. At 30 days, the incidence of death was 2.7%; stroke, 1.2%; and MV reintervention, 0.97%. MR success compared with an unsuccessful procedure was associated with significantly lower mortality (14.0% vs. 26.7%; adjusted hazard ratio [aHR], 0.49; 95% confidence interval [CI], 0.42-0.56; p < 0.001) and heart failure readmission (8.4% vs. 16.9%; aHR, 0.47; 95% CI, 0.41-0.54; p < 0.001) at 1 year. Among patients with MR success, the lowest mortality was observed in patients who had both < mild residual MR and mean mitral gradients of ≤5 mm Hg compared with those with an unsuccessful procedure (11.4% vs. 26.7%; aHR, 0.40; 95% CI, 0.34-0.47; p < 0.001).
Conclusions:
The authors report that in this registry-based study of patients with degenerative MR undergoing TMVr, the procedure was safe and resulted in successful repair in 88.9% of patients.
Perspective:
The national STS/ACC TVT Registry enrolling all consecutive patients undergoing TMVr for degenerative MR reports an excellent safety profile of TMVr, despite advanced age and presence of significant comorbidities. Furthermore, successful TMVr, defined as reduction of the severity of MR to moderate or less without severe stenosis, was achieved in 89% of patients undergoing TMVr. Successful TMVr, compared with those with unsuccessful repair, also had better survival and lower hospitalization and MV reintervention rates at 1 year. Given the inherent limitations of this observational study, prospective randomized clinical trials of surgery versus TMVr are needed to guide the optimal treatment of patients with degenerative MR.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Acute Heart Failure, Interventions and Structural Heart Disease, Mitral Regurgitation
Keywords: Aged, 80 and over, Cardiac Surgical Procedures, Cardiology Interventions, Comorbidity, Geriatrics, Heart Failure, Heart Valve Diseases, Mitral Valve Insufficiency, Mitral Valve Stenosis, Patient Readmission, Stroke, STS/ACC TVT Registry
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