Residual or recurrent mitral regurgitation predicts mortality following transcatheter edge-to-edge mitral valve repair

Stephen H McKellar; James Harkness; Bruce B Reid; Nishant K Sekaran; Heidi T May; Brian K Whisenant

doi:10.1016/j.xjon.2023.10.019

Residual or recurrent mitral regurgitation predicts mortality following transcatheter edge-to-edge mitral valve repair

JTCVS Open. 2023 Oct 31:16:191-206. doi: 10.1016/j.xjon.2023.10.019. eCollection 2023 Dec.

Authors

Stephen H McKellar¹, James Harkness², Bruce B Reid¹, Nishant K Sekaran², Heidi T May², Brian K Whisenant²

Affiliations

¹ Division of Cardiovascular Surgery, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah.
² Division of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah.

Abstract

Objective: Although regurgitant mitral valves can be repaired through surgical or transcatheter approaches, contemporary comparative outcomes are limited with the impact of residual and recurrent mitral regurgitation (MR) on clinical outcomes being poorly defined. We hypothesized that moderate (2+) or greater residual or recurrent (RR) MR-regardless of type of repair-predicts worse clinical outcomes.

Methods: Our institutional experience of 660 consecutive patients undergoing mitral valve repair (2015-2021) consisting of 393 surgical mitral valve repair (SMVr) and 267 transcatheter edge-to-edge mitral valve repair (TEER) was studied. The echocardiographic impact of RRMR (2+) following both SMVr and TEER on death and reintervention was evaluated.

Results: Patients averaged 67.8 ± 14.2 years (SMVr = 63.8 ± 13.3 vs 73.6 ± 13.6, P < .0001) and 62.1% were male. Baseline clinical and demographic data were vastly different between the 2 groups. Residual or recurrent 2+ or greater MR developed in 25% (n = 68) of patients who received TEER compared with 6% (n = 25) of SMVr (P < .0001). Reintervention (9.3% vs 2.4%, P = .002) and death (37.9% vs 10.4%, P < .0001) rates at 3-years were greater among the TEER group versus SMVr group. Given the heterogeneity in baseline characteristics and difference in survival, each cohort was analyzed separately, stratified by RRMR, using multivariable modeling to identify predictors of repeat reintervention and death. There were too few events of RRMR in the SMVr cohort for evaluation. For the TEER subgroups, we observed greater long-term mortality, but not reintervention among those with RRMR., Hypertension was the strongest predictor of death and obesity was for reintervention.

Conclusions: Patients undergoing SMVr and TEER are vastly different with respect to baseline patient characteristics and clinical outcomes, with patients who undergo TEER being much greater risk with poorer prognosis. Moderate or greater RRMR predicted worse long-term survival but not reintervention among patients who received TEER. Given the difference in survival among patients with RRMR following TEER, care must be taken to ensure that patients entering clinical trials and receiving TEER should have a high probability of achieving mild or less MR as seen in contemporary surgical results.

Keywords: mitral valve; mitral valve repair; surgical; transcatheter.