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MitraClip bests conservative therapy in symptomatic mitral regurgitation
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Compared with conservative management alone, transcatheter mitral valve repair had a lower mortality hazard for treatment of high-risk patients with symptomatic mitral regurgitation, according to a matched analysis published in Circulation: Cardiovascular Interventions.
“Long-term mortality for high-risk patients that receive the MitraClip intervention or conservative therapy remains high,” Friso Kortlandt, MD, from the department of cardiology at St. Antonius Hospital in Nieuwegein, the Netherlands, and colleagues wrote. “For high-risk patients with symptomatic mitral regurgitation, MitraClip intervention shows to be an independent factor that leads to lower mortality hazard when compared with conservative therapy.”
To evaluate the effects of treatment with transcatheter mitral valve repair (MitraClip, Abbott Vascular) on survival for a cohort of symptomatic high-surgical-risk patients with mitral regurgitation, compared with matched patients who underwent surgical or conservative therapy, Kortlandt and colleagues conducted a multicenter study of 1,036 patients in four Dutch centers.
A 5-year follow-up showed a low observed survival rate in the MitraClip cohort (39.8%), which was comparable to the conservative cohort (40.5%).
The surgical cohort experienced a 76.3% 5-year survival rate, but there were significant differences between the baseline characteristics of the three cohorts, with the MitraClip cohort having the highest comorbidity burden.
Using Cox regression, Kortlandt and colleagues adjusted for baseline differences and found the MitraClip and surgical cohorts showed similar survival ratios (HR = 0.92; 95% CI, 0.67-1.26), whereas, compared with conservative treatment, both cohorts were associated with a lower mortality hazard (HR for MitraClip vs. conservative = 0.61; 95% CI, 0.49-0.77; HR for surgery vs. conservative = 0.56; 95% CI, 0.42-0.76).
“This multicenter study strengthens the already existing concept that high-risk patients with symptomatic severe [mitral regurgitation] being treated with the MitraClip have a lower mortality hazard compared with patients who receive conservative treatment, whereas they have a similar survival compared with patients undergoing surgical treatment,” the researchers wrote. – by Dave Quaile
Disclosures: Kortlandt reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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