Transcatheter Edge-To-Edge Repair Is Favorable for Elderly Patients at High Surgical Risk

Mitral valve prolapse is the most frequent cause of mitral valve regurgitation and is associated to hospitalization for cardiac failure and mortality. At present, the preferred treatment for operable patients is mitral valve surgical repair.

En octogenarios de alto riesgo para cirugía la estrategia borde a borde es favorable

Transcatheter edge to edge repair (TEER) has shown great benefit patients at high surgical risk; however, it has not been well studied in the +80 population and therefore we currently have insufficient data on it. 

This analysis included 1187 patients, 872 receiving TEER (from the Mitra Swiss and Minneapolis Heart Institute Registries) and 315 presenting degenerative mitral regurgitation (DMR) caused by mitral valve prolapse, who were not operated (from the MIDAS registry).

Mean age was 82, and 44% were women.

Patients receiving TEER presented more hypertension, ischemic cardiomyopathy, atrial fibrillation, functional class III-IV, lower ejection fraction, greater left atrial and left ventricle diastolic diameters, pulmonary hypertension, and higher surgical risk. 

Read also: Is Increased Mitral Valve Gradient After MitraClip a Long-Term Prognostic Factor?

At 30 days and 6 months, mortality resulted lower for the TEER patients vs. DMR non operated patients: 3.6% vs 6.2% (odds ratio 0.55, 95% CI: 0.31–0.98; P=0.04) and 8.2% vs. 17.5% (odds ratio 0.42, 95% CI: 0.29–0.62; P <0.0001) respectively. At 4 years, survival also resulted better among the TEER patients (54% vs. 46% p <0.0001).

Because the populations were different, they were matched using Propensity Score, leaving 247 pairs of patients.

The TEER strategy presented improved 4-year survival (49% vs. 37%, P=0.002) vs DMS non operated patients. 

Read also: Impact of Edge to Edge Transcatheter Tricuspid Valve Repair.

 Procedural failure expressed by moderate/severe mitral regurgitation was associated to higher mortality at 4 years, similar that of non-operated patients. 

At multivariable analysis, mortality was associated to residual moderate/severe mitral regurgitation, age, surgical risk score, ejection fraction, atrial fibrillation, functional class, left ventricle diameter, left atrial diameter and pulmonary hypertension. 

Conclusion

In elderly patients with symptomatic degenerative mitral regurgitation and high risk for surgery, transcatheter edge-to-edge repair has been associated to better survival compared against non-surgical patients. Successfully controlling mitral valve regurgitation was key to improving survival, which should be taken into account when treating inoperable patients. 

Dr. Carlos Fava - Consejo Editorial SOLACI

Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.

Original Title: Association of transcatheter edge-to-edge repair with improved survival in older patients with severe, symptomatic degenerative mitral regurgitation.

Reference: Giovanni Benfar, et al. European Heart Journal (2022) 43, 1626–1635.


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