The Significance of Aetiology on Mitral Regurgitation

Courtesy of Dr. Carlos Fava.

The aetiology of mitral regurgitation (MR) may be divided into primary, organic or degenerative MR, and secondary or functional MR. These two present different physiopathology. The treatment strategy is different for each, and edge-to-edge treatment with Mitraclip is currently emerging as a valid alternative for high-risk patients.

This study analyzed 943 patients with MR and high surgical risk. Among them, 668 had functional causes (FMR) and 275 had degenerative causes (DMR).

For patients with FMR, the mean age was 72 years, the EuroSCORE II was 7.4, and the ejection fraction was 33%.

Three hundred and sixty-five patients received MitraClip, 95 underwent surgery (valve repair, mostly), and the remaining 228 patients received medical treatment.

Read also: TCT 2018 | REDUCE-FMR: Indirect Annuloplasty in Secondary Mitral Regurgitation.

The groups presented differences. Patients who received MitraClip were elderly compared with the group undergoing surgery, but similar in age to the group who received medical treatment. However, their risk score and comorbidities were higher than for the other two groups.

In the MitraClip group, procedural success was 97%.

Propensity score matching and Cox regression were used to reduce confounding variables among groups.

Read also: TCT 2018 | COAPT: MitraClip in Patients with Secondary Mitral Regurgitation.

After a 3-year follow-up, the medical treatment group presented higher mortality rates than the MitraClip group (hazard ratio [HR] 1.79; 95% confidence interval [CI]: 1.34 to 2.39; p < 0.001). On the other hand, there were no differences between the surgery group and the MitraClip group (HR: 0.86; 95% CI: 0.54 to 1.38; p = 0.541).

As regards DMR patients, there were no significant differences among strategies.

Conclusions

In high-risk FMR patients, MitraClip showed a reduction in mortality compared with medical treatment.

Courtesy of Dr. Carlos Fava.

Original title: Impact of Mitral Valve Treatment Choice on Mortality According to Aetiology.

Reference: Friso Kortlandt et al. EuroIntervention 2019;14:1733-1739.

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