Mitral valve surgery confers high risk after transcatheter edge-to-edge repair
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Among patients who received transcatheter edge-to-edge repair, mitral valve surgery was associated with risks for morbidity and mortality that were not negligible, according to researchers, with less than 10% undergoing the procedure.
“Our multicenter international study showed that the surgery after transcatheter edge-to-edge repair (TEER) is a high risk and does not allow repair as a second surgery,” Tsuyoshi Kaneko, MD, cardiac surgeon Brigham and Women’s Hospital and assistant professor of surgery at Harvard Medical School, said in a press release.
Currently, despite more than 100,000 mitral TEER procedures having been performed worldwide, longitudinal data on mitral valve surgery after TEER remain lacking, Kaneko and colleagues wrote. This led them to evaluate clinical and echocardiographic characteristics, mechanisms of failure and outcomes of mitral valve surgery after TEER.
The study featured retrospectively analyzed data from the multicenter, international CUTTING-EDGE registry. Overall, median follow-up was 9 months after mitral valve surgery, with follow-up 96.1% complete at 30 days and 81.1% complete at 1 year.
From July 2009 to July 2020, 332 patients (mean age, 74 years; 43% women) from 34 centers received mitral valve surgery after TEER.
Overall, patients had a median Society of Thoracic Surgeons risk for mitral valve repair at initial TEER of 4, whereas primary/mixed mitral regurgitation occurred in 59% of patients and secondary mitral regurgitation in 38.5% of patients. Additionally, the median interval from TEER to surgery was 3.5 months and median STS risk score for mitral valve replacement was 4.8%.
Researchers reported that recurrent mitral regurgitation was the primary indication for surgery at 33.5%. They performed mitral valve replacement in 92.5% of patients and concomitant tricuspid surgery in 42.2% of patients.
Moreover, the rate of mortality was 16.6% at 30 days, a figure that nearly doubled at 1 year (31.3%).
After performing Kaplan-Meier analysis, researchers found that actuarial mortality estimates were 24.1% at 1 year and 31.7% at 3 years after mitral valve surgery.
“The mortality and morbidity risks in mitral valve surgery after TEER are not negligible,” Kaneko said in the release. “Our findings should have a significant impact on choosing surgery vs. transcatheter therapy for eligible patients.”
Kaneko and colleagues noted in the study that the findings are hypothesis-generating and “will provide further insights into patients after TEER who may require mitral valve surgery in the future.”
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