TY - JOUR

T1 - Transcatheter mitral valve replacement or repair for secondary mitral regurgitation

T2 - a propensity score-matched analysis

AU - Ludwig, Sebastian

AU - Kalbacher, Daniel

AU - Ali, Walid Ben

AU - Weimann, Jessica

AU - Adam, Matti

AU - Duncan, Alison

AU - Webb, John G.

AU - Windecker, Stephan

AU - Orban, Mathias

AU - Giannini, Cristina

AU - Coisne, Augustin

AU - Karam, Nicole

AU - Scotti, Andrea

AU - Sondergaard, Lars

AU - Adamo, Marianna

AU - Muller, David W.M.

AU - Butter, Christian

AU - Denti, Paolo

AU - Melica, Bruno

AU - Regazzoli, Damiano

AU - Garatti, Andrea

AU - Schmidt, Tobias

AU - Andreas, Martin

AU - Dahle, Gry

AU - Taramasso, Maurizio

AU - Nickenig, Georg

AU - Dumonteil, Nicolas

AU - Walther, Thomas

AU - Flagiello, Michele

AU - Kempfert, Joerg

AU - Fam, Neil

AU - Ruge, Hendrik

AU - Rudolph, Tanja K.

AU - Wyler von Ballmoos, Moritz C.

AU - Metra, Marco

AU - Redwood, Simon

AU - Granada, Juan F.

AU - Tang, Gilbert H.L.

AU - Latib, Azeem

AU - Lurz, Philipp

AU - von Bardeleben, Ralph Stephan

AU - Modine, Thomas

AU - Hausleiter, Jörg

AU - Conradi, Lenard

AU - on behalf of the CHOICE-MI and the EuroSMR Investigators (see online Appendix S1)

N1 - Publisher Copyright: © 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PY - 2023

Y1 - 2023

N2 - Aims: This study aimed to compare outcomes after transcatheter mitral valve replacement (TMVR) and mitral valve transcatheter edge-to-edge repair (M-TEER) for the treatment of secondary mitral regurgitation (SMR). Methods and results: The CHOICE-MI registry included 262 patients with SMR treated with TMVR between 2014 and 2022. The EuroSMR registry included 1065 patients with SMR treated with M-TEER between 2014 and 2019. Propensity score (PS) matching was performed for 12 demographic, clinical and echocardiographic parameters. Echocardiographic, functional and clinical outcomes out to 1 year were compared in the matched cohorts. After PS matching, 235 TMVR patients (75.5 years [70.0, 80.0], 60.2% male, EuroSCORE II 6.3% [interquartile range 3.8, 12.4]) were compared to 411 M-TEER patients (76.7 years [70.1, 80.5], 59.0% male, EuroSCORE II 6.7% [3.9, 12.4]). All-cause mortality was 6.8% after TMVR and 3.8% after M-TEER at 30 days (p = 0.11), and 25.8% after TMVR and 18.9% after M-TEER at 1 year (p = 0.056). No differences in mortality after 1 year were found between both groups in a 30-day landmark analysis (TMVR: 20.4%, M-TEER: 15.8%, p = 0.21). Compared to M-TEER, TMVR resulted in more effective mitral regurgitation (MR) reduction (residual MR ≤1+ at discharge for TMVR vs. M-TEER: 95.8% vs. 68.8%, p < 0.001), and superior symptomatic improvement (New York Heart Association class ≤II at 1 year: 77.8% vs. 64.3%, p = 0.015). Conclusion: In this PS-matched comparison between TMVR and M-TEER in patients with severe SMR, TMVR was associated with superior reduction of MR and superior symptomatic improvement. While post-procedural mortality tended to be higher after TMVR, no significant differences in mortality were found beyond 30 days.

AB - Aims: This study aimed to compare outcomes after transcatheter mitral valve replacement (TMVR) and mitral valve transcatheter edge-to-edge repair (M-TEER) for the treatment of secondary mitral regurgitation (SMR). Methods and results: The CHOICE-MI registry included 262 patients with SMR treated with TMVR between 2014 and 2022. The EuroSMR registry included 1065 patients with SMR treated with M-TEER between 2014 and 2019. Propensity score (PS) matching was performed for 12 demographic, clinical and echocardiographic parameters. Echocardiographic, functional and clinical outcomes out to 1 year were compared in the matched cohorts. After PS matching, 235 TMVR patients (75.5 years [70.0, 80.0], 60.2% male, EuroSCORE II 6.3% [interquartile range 3.8, 12.4]) were compared to 411 M-TEER patients (76.7 years [70.1, 80.5], 59.0% male, EuroSCORE II 6.7% [3.9, 12.4]). All-cause mortality was 6.8% after TMVR and 3.8% after M-TEER at 30 days (p = 0.11), and 25.8% after TMVR and 18.9% after M-TEER at 1 year (p = 0.056). No differences in mortality after 1 year were found between both groups in a 30-day landmark analysis (TMVR: 20.4%, M-TEER: 15.8%, p = 0.21). Compared to M-TEER, TMVR resulted in more effective mitral regurgitation (MR) reduction (residual MR ≤1+ at discharge for TMVR vs. M-TEER: 95.8% vs. 68.8%, p < 0.001), and superior symptomatic improvement (New York Heart Association class ≤II at 1 year: 77.8% vs. 64.3%, p = 0.015). Conclusion: In this PS-matched comparison between TMVR and M-TEER in patients with severe SMR, TMVR was associated with superior reduction of MR and superior symptomatic improvement. While post-procedural mortality tended to be higher after TMVR, no significant differences in mortality were found beyond 30 days.

KW - Functional mitral regurgitation

KW - Secondary mitral regurgitation

KW - Transcatheter edge-to-edge repair

KW - Transcatheter mitral valve replacement

U2 - 10.1002/ejhf.2797

DO - 10.1002/ejhf.2797

M3 - Journal article

C2 - 36883620

AN - SCOPUS:85150515553

VL - 25

SP - 399

EP - 410

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1567-4215

IS - 3

ER -