Transcatheter mitral valve replacement or repair for secondary mitral regurgitation: a propensity score-matched analysis
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This study aimed to compare outcomes after transcatheter mitral valve replacement (TMVR) and mitral valve transcatheter edge-to-edge repair (M-TEER) for the treatment of secondary mitral regurgitation (SMR).
Methods and results
The CHOICE-MI registry included 262 patients with SMR treated with TMVR between 2014 and 2022. The EuroSMR registry included 1065 patients with SMR treated with M-TEER between 2014 and 2019. Propensity score (PS) matching was performed for 12 demographic, clinical and echocardiographic parameters. Echocardiographic, functional and clinical outcomes out to 1 year were compared in the matched cohorts. After PS matching, 235 TMVR patients (75.5 years [70.0, 80.0], 60.2% male, EuroSCORE II 6.3% [interquartile range 3.8, 12.4]) were compared to 411 M-TEER patients (76.7 years [70.1, 80.5], 59.0% male, EuroSCORE II 6.7% [3.9, 12.4]). All-cause mortality was 6.8% after TMVR and 3.8% after M-TEER at 30 days (p = 0.11), and 25.8% after TMVR and 18.9% after M-TEER at 1 year (p = 0.056). No differences in mortality after 1 year were found between both groups in a 30-day landmark analysis (TMVR: 20.4%, M-TEER: 15.8%, p = 0.21). Compared to M-TEER, TMVR resulted in more effective mitral regurgitation (MR) reduction (residual MR ≤1+ at discharge for TMVR vs. M-TEER: 95.8% vs. 68.8%, p < 0.001), and superior symptomatic improvement (New York Heart Association class ≤II at 1 year: 77.8% vs. 64.3%, p = 0.015).
Conclusion
In this PS-matched comparison between TMVR and M-TEER in patients with severe SMR, TMVR was associated with superior reduction of MR and superior symptomatic improvement. While post-procedural mortality tended to be higher after TMVR, no significant differences in mortality were found beyond 30 days.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | European Journal of Heart Failure |
| Vol/bind | 25 |
| Udgave nummer | 3 |
| Sider (fra-til) | 399-410 |
| Antal sider | 12 |
| ISSN | 1388-9842 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:
This work was supported by a grant from the German Heart Foundation (DHS) [grant number S/04/21] to Dr. Ludwig. Conflict of interest: S.L. has received travel compensation from Edwards LifeSciences, speaker honoraria from Abbott Medical and advisory fees from Bayer. D.K. has received speaker honoraria from Abbott Medical and Edwards LifeSciences; has received travel expenses from Abbott Medical and Edwards LifeSciences; and has received proctor fees from Edwards LifeSciences.
Funding Information:
: S.L. has received travel compensation from Edwards LifeSciences, speaker honoraria from Abbott Medical and advisory fees from Bayer. D.K. has received speaker honoraria from Abbott Medical and Edwards LifeSciences; has received travel expenses from Abbott Medical and Edwards LifeSciences; and has received proctor fees from Edwards LifeSciences. W.B.A. received research grants from Medtronic and Edwards LifeSciences. M.A. reports personal fees from Edwards and Boston Scientific, grants, and personal fees from Medtronic, during the conduct of the study. A.D. is a consultant for and has and received honoraria from Abbott Laboratories, Edward LifeSciences and Medtronic. S.W. has received research grants from Abbott Medical and Edwards LifeSciences. A.C. is proctor for Abbott Vascular and speaker for Abbott Vascular and GE Healthcare. N.K. has received consultant fees from Abbott Medical. G.D. is proctor/speaker for Abbott and speaker for Edwards. M.T. is a consultant for Abbott, Edwards LifeSciences, Boston Scientific, Shenqi Medical, Simulands, Occlufit, MTEx, MEDIRA, 4tech and CoreMedic, and received fees from Cardiovalve. N.D. is a consultant for and received proctoring fees from Abbott Vascular, Boston Scientific, Edwards LifeSciences and Medtronic. J.K. received speaker honoraria from Edwards, Medtronic, Abbott and CryoLife. H.R. is a member of the advisory board of Abbott and a physician proctor for Abbott and Edwards LifeSciences. T.K.R. received speaker honoraria from Abbott Vascular. G.H.L.T. is a physician proctor and consultant for Medtronic, consultant and TAVR physician advisory board member for Abbott Structural Heart, consultant for NeoChord and advisory board member for JenaValve. P.L. has received speaker honoraria from Abbott Medical; and has received consultant fees from Abbott Medical and Edwards LifeSciences. R.S.V.B. has received consulting and speaker honoraria from Abbott Vascular, Edwards LifeSciences and Medtronic, as well as research project grants paid to the university from Abbott Vascular and Edwards LifeSciences. J.H. has received consulting fees, speaker honoraria, and support of research projects paid to the institution from Abbott Vascular and Edwards LifeSciences. L.C. is advisory board member for Abbott, Medtronic and BostonScientific and has received personal fees from Edwards LifeSciences. All other authors have nothing to disclose. Conflict of interest
Funding Information:
This work was supported by a grant from the German Heart Foundation (DHS) [grant number S/04/21] to Dr. Ludwig.
Publisher Copyright:
© 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
ID: 367123095