Surgical versus transcatheter repair for secondary mitral regurgitation: A propensity score-matched cohorts comparison
| Autor: | Sonja Widmer, Peter Wenaweser, Jürg Grünenfelder, Thomas Pilgrim, Patric Biaggi, Mischa Külling, Stephan Windecker, Maks Mihalj, Roberto Corti, David Reineke, Taishi Okuno, Fabien Praz, Alexander Kadner, Mohammad Kassar |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Mitral valve repair Mitral regurgitation business.industry medicine.medical_treatment MitraClip Hazard ratio EuroSCORE Cardiac surgery medicine.anatomical_structure Internal medicine Mitral valve Propensity score matching medicine Cardiology Surgery 610 Medizin und Gesundheit Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of thoracic and cardiovascular surgery. |
| ISSN: | 1097-685X |
| Popis: | Objectives: To compare the efficacy and clinical outcomes of transcatheter edge-to-edge mitral valve repair (TMVr) and surgical mitral valve repair (SMVr) among patients with secondary mitral regurgitation (SMR). Methods: Consecutive patients with SMR treated using either TMVr (n = 199) or SMVr (n = 222) at 2 centers were included and retrospectively analyzed. To account for differences in patient demographic characteristics, 1:1 propensity score matching was performed. The primary endpoint was all-cause death within 2 years after the procedure. Results: The study population consisted of 202 matched patients. At 2 years, all-cause mortality was 24.3% for TMVr and 23.0% for SMVr (hazard ratio, 0.97; 95% confidence interval, 0.55-1.71; P = .909). Severe heart failure symptoms at 2 years were less prevalent after SMVr (New York Heart Association functional class III or IV: 13.5% vs 29.5%; P = .032) than after TMVr. A higher proportion of the SMVr patients had SMR reduction to none or mild at discharge (90.8% vs 72.0%; P < .001) and 2 years (86.5% vs 59.6%; P < .001). Among patients who achieved none or mild MR at discharge, 7 patients (10.1%) in the SMVr group and 15 (34.9%) in the TMVr group had progression to moderate or greater MR at 2 years (P = .003). Left ventricular ejection fraction (LVEF) significantly improved (+10.1% �� 11.1%; P < .001) after SMVr (LVEF at 2 years: 45.7% �� 12.8%), whereas it remained unchanged (-1.3% �� 8.9%; P = .260) after TMVr (LVEF at 2 years: 34.0% �� 13.2%). Conclusions: In this propensity score-matched analysis, there was no significant difference in 2-year survival between TMVr and SMVr, despite greater and more durable SMR reduction, as well as LVEF improvement in the surgical group. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|