Propensity Score Matched Comparison of Transcatheter Edge-to-Edge Mitral Valve Repair versus Minimally invasive Mitral Valve Surgery

Background: Minimally invasive mitral valve surgery (MIC-MVS) has been established as gold standard treatment of mitral regurgitation (MR), but transcatheter edge-to-edge valve repair (TEER) is an increasingly performed alternative in patients at high surgical risk. Up to date, there is no study comparing both treatment options. This study evaluated outcomes of patients with MR after TEER in comparison to MIC-MVS.

Method: From 2008 to 2021, we performed 720 TEER and 105 isolated MIC-MVS. Patients with concomitant tricuspid valve surgery were excluded. We applied propensity score-matching age, NYHA class, left ventricular ejection fraction (LVEF), EuroSCORE II, etiology of MR (primary/secondary/mixed), and grade of tricuspid regurgitation).

Results: Propensity-matching yielded 40 pairs (n = 80). Age was 69.9 years (95% CI: 66.8–72.9) in TEER versus 70.5 years (95% CI: 68.6–72.4) in MIC-MVS (p = 0.74). In both groups, 60.0% (24/40) were in NYHA class III/IV (p = 1.00). LVEF was 61.2% (95% CI: 57.9–64.4) versus 60.3% (95% CI: 57.7–62.8) (p = 0.67), EuroSCORE II was 1.8% (95% CI: 1.5–2.2) versus 1.8% (95% CI: 1.3–2.3) (p = 0.95). MR etiology was primary in 80.0% (32/40) and secondary in 20.0% (8/40) in both groups (p = 1.00). No clips could be placed in 17.5% (7/40) in TEER. In MIC-MVS, 97.5% (39/40) of valves were repaired and 2.5% replaced. There was no conversion to sternotomy. Mortality at 30 days was 2.5% in both groups (1/40; p = 1.00). Strokes occurred in 2.5% in each group (1/40; p = 1.00). ICU/hospital stay was longer after MIC-MVS (p < 0.01). Grade of MR at discharge was moderate/severe in 51.1% (20/39) in TEER versus 13.1% (5/38) in MIC-MVS (p < 0.01). Mean mitral valve gradient was higher after TEER being 4.1 mm Hg (3.4–4.7) versus 3.3 mm Hg (2.9–3.7, p = 0.042). One year survival was 95.0% in TEER versus 97.5% in MIC-MVS (p = 0.56). During follow-up, 17.5% (7/40) of TEER patients were reoperated on the mitral valve after a mean of 379.0 days (35.6–793.7), whereas no patient was reoperated in the MIC-MVS group (p < 0.01).

Conclusion: In this propensity matched comparison of TEER and MIC-MVS in patients with predominantly primary MR, mortality at 30 days and 1 year was comparable, as was the rate of stroke. Length of stay on intensive care unit and hospital stay were significantly shorter in TEER. In contrast, reduction of MR was less effective and resulted in higher mean transvalvular gradients leading to a higher reoperation rate during follow-up after TEER.

Publikationsverlauf

Artikel online veröffentlicht:
28. Januar 2023