Survival rates similar when treating secondary MR with TEER or surgery
Transcatheter edge-to-edge repair (TEER) and surgical mitral valve repair (SMVR) are associated with comparable two-year survival rates, according to a new analysis published in the Journal of Thoracic and Cardiovascular Surgery. Patients undergoing SMVR, however, saw a more consistent reduction in secondary mitral regurgitation (SMR).
The study’s authors explored data from 421 patients who presented with SMR at one of two hospitals in Switzerland. While 199 patients underwent TEER—previously known as transcatheter mitral valve repair (TMVR)—with the MitraClip device, 222 patients underwent SMVR. All patients received care from 2005 to 2018. Various surgical techniques were determined by each surgeon. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting were performed when necessary.
Patients treated with surgery were more likely to be male than patients treated with TEER/TMVR, the authors noted. Also, previous PCI and severe mitral regurgitation were “significantly higher” in the TEER group.
Overall, the authors found, the all-cause mortality rates after 30 days were 4% in the SMVR group and 7% in the TEER group. After two years, the all-cause mortality rates were 23% in the SMVR group and 24.3% in the TEER group.
The authors also assessed data related to heart failure symptoms after two years in 89.5% of the patient population. While 13.3% of the SMVR group were New York Heart Association functional class III or IV, that number was 29.5% among the TEER group.
Echocardiographic data, meanwhile, showed that 90.8% of SMVR patients and 72% of TEER patients had “mild or less” residual mitral regurgitation. Severe residual mitral regurgitation was seen in 2% of SMVR patients and 3% of TEER patients.
Also, while left ventricular ejection fraction (LVEF) remained relatively unchanged among TEER patients, it “significantly improved” for SMVR patients.
“The surgical results compare favorably with contemporary literature with low 30-day mortality and durable MR reduction in >85% of patients throughout 2 years of follow-up,” wrote lead author Taishi Okuno, MD, a cardiologist at the University of Bern in Switzerland, and colleagues. “This contrasts with the high recurrence rate (59% at 2-year follow-up) reported in the randomized trial piloted by the Cardio-Thoracic Surgery Network comparing mitral valve repair and replacement for the treatment of SMR. While it is unclear whether differences in terms of surgical techniques, medical therapy, or patient selection influenced the low recurrence rate in our cohort, this observation seems to support the use of SMVR over mitral valve replacement as first-line option in patients with SMR. Although patients undergoing SMVR had fewer HF symptoms, this did not translate into a survival benefit at 24 months.”
The full study is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.