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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Transcatheter edge-to-edge repair versus mitral valve surgery in octogenarians: Comparative analysis of safety,
Sina Danesh1, Hartzell V Schaff1, Kimberly A Holst1
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Objective:
To investigate the short- and long-term outcomes of surgical and transcatheter interventions for treating mitral regurgitation (MR) in patients age ≥80 years.
Methods:
Between 2014 and 2024, 744 patients age ≥80 years underwent mitral valve (MV) surgery (n = 390) or transcatheter edge-to-edge repair (TEER; n = 354) at our institution. Of these, 466 patients without additional procedures or MV stenosis met the inclusion criteria. Application of 1:1 propensity score matching yielded a final matched cohort of 252 patients.
Results:
After matching, baseline characteristics were comparable between the TEER and MV surgery groups. In the entire study cohort, the median patient age was 83.5 years (interquartile range, 81.7-85.9 years), and 78.2% had degenerative MR. Thirty-day mortality was similar in the 2 groups (MV surgery, 1.6%; TEER, 0.8%; P = .561). Postoperatively, the MV surgery group had higher rates of atrial fibrillation, prolonged mechanical ventilation, and longer intensive care unit and hospital stays (P < .001 for all). Predischarge echocardiography showed less residual MR (2.4% vs 8%; P < .001), less tricuspid regurgitation (10.5% vs 50%, P < .001), and lower right ventricular systolic pressure (37.5 mm Hg vs 44 mm Hg; P < .001) in the MV surgery group. Over a median 3.9-year follow-up, the incidence of recurrent MR remained lower (6.4% vs 33.3%; P < .001), and 5-year survival was superior (68% vs 56%; P = .019) in the MV surgery group.
Conclusions:
Both surgical correction of MR and TEER can be performed relatively safely in octogenarians. Although TEER is associated with shorter hospital stays and fewer procedure-related complications, MV surgery results in a lower rate of recurrent MR and better late survival.
Insights
Mitral valve surgery in octogenarians offers better long-term survival and less recurrent mitral regurgitation (MR) compared to transcatheter edge-to-edge repair (TEER). TEER, however, is linked to shorter hospital stays and fewer complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Few real-world studies compare transcatheter edge-to-edge repair (TEER) and mitral valve (MV) surgery outcomes in patients aged 80 years and older.
- Mitral regurgitation (MR) management in octogenarians presents unique challenges due to comorbidities and frailty.
Purpose of the Study:
- To compare the short- and long-term outcomes of surgical and transcatheter interventions for MR in patients aged 80 years or older.
- To evaluate the safety and efficacy of TEER versus MV surgery in an octogenarian population.
Main Methods:
- A retrospective analysis of 744 patients aged 80+ undergoing MV surgery or TEER from 2014-2024.
- A 1:1 propensity score matched cohort of 252 patients (126 surgery, 126 TEER) was created after excluding patients with additional procedures or MV stenosis.
Main Results:
- Thirty-day mortality was similar between groups (1.6% surgery vs. 0.8% TEER).
- Surgical repair was associated with less residual MR (2.4% vs. 8%), less tricuspid regurgitation (10.5% vs. 50%), and lower RV systolic pressure (37.5 vs. 44 mmHg).
- Over a median 3.9-year follow-up, surgery demonstrated lower recurrent MR (6.4% vs. 33.3%) and superior five-year survival (68% vs. 56%).
Conclusions:
- Both MV surgery and TEER are viable options for octogenarians with MR.
- MV surgery provides superior long-term outcomes regarding recurrent MR and survival, despite higher rates of postoperative complications and longer hospital stays.
- TEER offers advantages in terms of shorter hospital stays and fewer procedure-related complications.
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