Original title: Survival of transcatheter mitral valve repair compared with surgical and conservative treatment in high-surgical-risk patients. Reference: Swaans MJ et al. J Am CollCardiolIntv. 2014;7:875-881.
In high-surgical-risk patients with symptomatic severe mitral valve regurgitation, MitraClip for transcatheter mitral valve repair and surgery showed similar survival rates in addition to superiority when compared to standard medical treatment.
This retrospective study of one center included 139 patients treated with MitraClip (Abbott Vascular, Santa Clara, CA) between 2009 and 2013. Survival rates were compared to a similar cohort of patients treated with surgery (n=53) and medical treatment (n=59) before the MitraClip obtained the CE European Mark.
All patients presented moderate to severe or severe (grades 3 and 4) mitral regurgitation and were symptomatic, with or without ejection fraction failure (<60%) or left ventricular dilation (end-systolic diameter >45 mm). Surgical risk was based on EuroSCORE. The three groups presented similar baseline characteristics, though patients receiving MitraClip had a higher EuroSCORE than the other two.
Most of patients in the three groups presented functional mitral failure (77% MitraClip group, 58.5% surgery group, and 81.3% medical treatment group).
At one year follow up, a similar survival benefit was observed in the MitraClip and surgery groups (85.8% vs. 85.2%) in contrast to the medical treatment group outcomes (survival 67.7%). At 2 and 3 years follow up, the initial trend was observed.
After propensity score matching, survival rates in the MitraClip and surgery groups were still higher than those in the medical treatment group (HR 1.25; CI 95% 0.72 to 2.16).
When considering mitral failure patients only, the difference between the MitraClip and the medical treatment groups was smaller, though still important, whereas the difference between the medical treatment group and the surgery group disappeared.
Conclusion
Though the EuroSCORE was higher in the MitraClip group, these high risk patients with severe symptomatic mitral valve regurgitation showed a similar survival rate than patients treated with surgery and both groups of patients showed a higher survival rate when compared to patients who received medical treatment.
Editorial Comment
This study has several methodology limitations: three retrospective groups, in different periods and not very well matched will only generate hypothesis and proper assessment require further studies, such as the COAPT and RESHAPE-HF, both already in course. However, it does state the clinical standard practice in many European centers.
SOLACI