STS/ACC TVT Registry Analysis Finds TMVr Safe and Effective in Real-World Setting

Transcatheter edge-to-edge repair (TEER) in patients with degenerative mitral regurgitation (MR) was found to be safe with a close to 90% success rate, according to an analysis of STS/ACC TVT Registry data presented at ACC.23/WCC.

In the largest study to examine outcomes of transcatheter mitral valve repair (TMVr) outside of the clinical trial setting, Raj R. Makkar, MD, FACC, et al., analyzed 19,088 patients (average age 82 years, 49% women, median risk of death within 30 days of surgery 4.6%) who underwent TEER with the MitraClip device for moderate to severe isolated degenerative MR from Jan. 1, 2014 to June 30, 2022. Patients who had undergone surgery or a previous transcatheter procedure to repair a mitral valve were excluded, along with those with secondary MR.

The study’s primary endpoint, MR success defined as moderate or better residual MR without severe stenosis, was achieved in 88.9% of patients. Optimal MR success, MR of mild or less severity without severe stenosis, was observed in 64.2% of patients.

Secondary endpoints compared clinical outcomes among successful and unsuccessful procedures captured by the registry including mortality at one year (14.0% vs. 26.7%; adjusted hazard ratio [HR], 0.49; 95% CI, 0.42-0.56; p<0.001), heart failure readmission at one year (8.4% vs. 16.9%; HR, 0.47; 95% CI, 0.41-0.54; p<0.001) and mitral valve reintervention at one year (2.1% vs. 13.5%; HR, 0.15; 95% CI, 0.12-0.19; p<0.001). Among patients with successful procedures, mortality at one year was lower for those with residual MR of mild or less severity than for those of moderate severity (12.3% vs. 18%).

Researchers also noted an increase in the rate of procedural success over time, citing greater physician experience with the procedure and technological advances in successive generations of the MitraClip device.

“We found that over the eight-year period that we studied, the procedural success rate increased from 81.5% in 2014 to 92.2% in 2022,” said Makkar. “Optimal success – a reduction in residual mitral leakage to mild or less – was attained in 64% of patients overall, but that increased from 44.6% in 2014 to 71.7% in 2022.”

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ACC Annual Scientific Session, ACC23, Angiography, Cardiac Surgical Procedures, National Cardiovascular Data Registries, STS/ACC TVT Registry, ACC.23/WCC Meeting Newspaper, ACC Scientific Session Newspaper

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