Surgery and transcatheter intervention for degenerative mitral regurgitation in the United States

Joanna Chikwe; Qiudong Chen; Michael E Bowdish; Amy Roach; Dominic Emerson; Annetine Gelijns; Natalia Egorova

doi:10.1016/j.jtcvs.2024.01.014

Surgery and transcatheter intervention for degenerative mitral regurgitation in the United States

J Thorac Cardiovasc Surg. 2024 Jan 17:S0022-5223(24)00027-8. doi: 10.1016/j.jtcvs.2024.01.014. Online ahead of print.

Authors

Joanna Chikwe¹, Qiudong Chen², Michael E Bowdish², Amy Roach², Dominic Emerson², Annetine Gelijns³, Natalia Egorova³

Affiliations

¹ Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif. Electronic address: Joanna.Chikwe@cshs.org.
² Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.
³ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.

PMID: 38237762
DOI: 10.1016/j.jtcvs.2024.01.014

Abstract

Objectives: We evaluated practice trends and 3-year outcomes of transcatheter edge-to-edge repair (TEER) and surgical repair for degenerative mitral regurgitation in the United States.

Methods: From the Centers for Medicare and Medicaid Services data (2012-2019), 53,117 mitral valve interventions (surgery or TEER) were performed for degenerative mitral regurgitation, identified by excluding rheumatic and congenital disease, endocarditis, myocardial infarction, cardiomyopathy, and concomitant or prior coronary revascularizations. Median follow-up was 2.9 years (interquartile range, 1.2-5.1 years). End points were 3-year survival, stroke, mitral reinterventions, and heart failure readmissions.

Results: Volume of total annual mitral interventions did not significantly change (P = .18) between 2012 and 2019. However, surgical cases decreased by one-third, whereas TEER increased. Among 27,170 patients (52.5% men; mean age, 73.5 years) who underwent TEER (n = 7755) or surgical repair (n = 19,415), surgical patients were younger (71.8 vs 80.8 years; P < .001), with less comorbidity and frailty. In 4532 patient pairs matched for age, frailty, and comorbidity, 3-year survival after TEER was 65.9% (95% CI, 64.3%-67.6%) and 85.7% (95% CI, 84.5%-86.9%) after surgery (P < .001). Three years after TEER or surgery, stroke rates were 1.8% (95% CI, 1.5%-2.2%) and 2.0% (95% CI, 1.6%-2.4%) (P = .49); heart failure readmission rates were 17.8% (95% CI, 16.7%-18.9%) and 11.2% (95% CI, 10.3%-12.2%) (P < .001); and mitral reintervention rates were 6.1% (95% CI, 5.5%-6.9%) and 1.3% (95% CI, 1.0%-1.7%) (P < .001), respectively.

Conclusions: Among Medicare beneficiaries with degenerative mitral regurgitation, an increase in TEER utilization was associated with worse survival, increased heart failure readmissions, and more mitral reinterventions. Randomized trials are needed to better inform treatment choice.

Keywords: degenerative mitral regurgitation; mitral repair; mitral valve surgery; transcatheter edge-to-edge repair.