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Transcatheter or surgical repair for degenerative mitral regurgitation in elderly patients: A propensity-weighted

Nicola Buzzatti1, Mathias Van Hemelrijck2, Paolo Denti1

  • 1Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy.

The Journal of Thoracic and Cardiovascular Surgery
|February 25, 2019
PubMed
Abstract

Insights

MitraClip reduced early complications and improved 1-year survival for elderly degenerative mitral regurgitation (DMR) patients. However, it led to higher recurrence of mitral regurgitation (MR) and lower long-term survival compared to surgical repair.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Degenerative mitral regurgitation (DMR) affects elderly patients, posing treatment challenges.
  • Transcatheter edge-to-edge repair (MitraClip) and surgical mitral repair are options for DMR.
  • Risk stratification is crucial for selecting appropriate treatment in elderly patients.

Purpose of the Study:

  • To compare the clinical outcomes of MitraClip versus surgical mitral repair in low-intermediate risk elderly patients with DMR.
  • To evaluate short-term and long-term survival and complication rates for both procedures.

Main Methods:

  • Retrospective study of patients aged ≥75 years with Society of Thoracic Surgeons Predicted Risk Of Mortality (STS-PROM) <8%.
  • Comparison between MitraClip (n=100) and isolated surgical repair (n=206) for DMR.
  • Propensity score weighting used to adjust for baseline differences and estimate average treatment effect on survival.

Main Results:

  • MitraClip demonstrated fewer postoperative complications but higher residual mitral regurgitation (MR) ≥2 (27.0% vs 2.8%).
  • One-year survival was superior with MitraClip (97.6% vs 95.3%), but 5-year survival was significantly lower (34.5% vs 82.2%).
  • Higher STS-PROM and MR ≥3+ recurrence were associated with reduced survival; 5-year MR ≥3+ was more frequent after MitraClip (36.9% vs 3.9%).

Conclusions:

  • MitraClip offers reduced acute complications and improved 1-year survival in select elderly DMR patients.
  • However, MitraClip is associated with increased MR recurrence and diminished long-term survival beyond one year.
  • Transcatheter mitral repair requires improved durability and efficacy for long-term patient benefit in operable candidates.
Keywords:
Mitraclipdegenerativemitral regurgitationmitral repairprolapsetranscatheter

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