Mitral Surgery After Transcatheter Edge-to-Edge Repair: Society of Thoracic Surgeons Database Analysis

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Outcomes

Background:

• Transcatheter edge-to-edge (TEER) mitral repair can result in residual or recurrent mitral regurgitation.
• There is a growing need for surgical reintervention after TEER, but outcomes data are limited.

Purpose of the Study:

• To evaluate national outcomes of mitral surgery following TEER.
• To identify predictors of mortality and assess the surgical repair rate after failed TEER.

Main Methods:

• Analysis of the STS Adult Cardiac Surgery Database for 524 adults undergoing mitral surgery post-TEER (July 2014-June 2020).
• Exclusion of emergency cases, prior mitral surgery, and open transcatheter prosthesis implantation.
• Primary outcome: 30-day or in-hospital mortality.

Main Results:

• In 463 patients, observed mortality was 10.2% (expected 6.5%), with predictors including urgent surgery, non-degenerative etiology, high creatinine, and age >80.
• Higher mortality was observed in centers performing fewer cases (<10/year).
• The surgical repair rate after failed TEER was 4.8%.

Conclusions:

• Mitral repair is infrequently achieved after TEER failure.
• Findings suggest implications for treatment choices in younger, lower-risk patients and for TEER patient consent and clinical trial design.