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Transcatheter versus surgical mitral valve repair in patients with mitral regurgitation

Monil Majmundar1, Kunal Nitinkumar Patel2, Rajkumar Doshi3

  • 1Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, USA.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|November 24, 2023
PubMed
Abstract

Insights

Transcatheter mitral valve repair (TMVr) shows higher medium-term risks than surgical repair (SMVr) in primary mitral regurgitation and heart failure patients. Shared decision-making is crucial for TMVr, weighing benefits against risks compared to SMVr.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Heart Valve Disease

Background:

  • Mitral regurgitation (MR) is a common valvular heart disease.
  • Heart failure with reduced ejection fraction (HFrEF) often coexists with MR.
  • Transcatheter mitral valve repair (TMVr) offers a less invasive alternative to surgical mitral valve repair (SMVr).

Purpose of the Study:

  • To compare clinical outcomes of TMVr versus SMVr.
  • To evaluate TMVr and SMVr in patients with primary MR.
  • To assess TMVr and SMVr in patients with MR and HFrEF.

Main Methods:

  • Retrospective cohort study using the Nationwide Readmission Database (2016-2019).
  • 1:1 propensity score matching for patients undergoing TMVr or SMVr.
  • Primary outcome: composite of major adverse cardiovascular events (MACE); Secondary outcome: in-hospital mortality.

Main Results:

  • 2187 matched pairs for primary MR and 2178 for MR-HFrEF.
  • TMVr demonstrated significantly higher medium-term MACE than SMVr in both cohorts (primary MR HR 1.73; MR-HFrEF HR 2.00).
  • In-hospital mortality was similar between TMVr and SMVr in both groups.

Conclusions:

  • TMVr has higher medium-term MACE compared to SMVr in primary MR and MR-HFrEF.
  • While TMVr may offer short-term benefits, SMVr shows superior medium-term results.
  • Shared decision-making is essential to discuss TMVr risks and benefits versus SMVr eligibility.
Keywords:
Major adverse cardiovascular eventsMitral regurgitationMortalitySurgical mitral valve repairTranscatheter mitral valve repair

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