Impact of Mitral Regurgitation Etiology on Mitral Surgery After Transcatheter Edge-to-Edge Repair - Université de Rennes Accéder directement au contenu
Article Dans Une Revue JACC: Cardiovascular Interventions Année : 2023

Impact of Mitral Regurgitation Etiology on Mitral Surgery After Transcatheter Edge-to-Edge Repair

Marisa Avvedimento
  • Fonction : Auteur
Keti Vitanova
  • Fonction : Auteur
Serdar Akansel
  • Fonction : Auteur
Oliver Bhadra
  • Fonction : Auteur
Guido Ascione
  • Fonction : Auteur
Shekhar Saha
  • Fonction : Auteur
Thilo Noack
  • Fonction : Auteur
Ana Paula Tagliari
Alejandro Pizano
  • Fonction : Auteur
Marissa Donatelle
  • Fonction : Auteur
John Squiers
Kashish Goel
  • Fonction : Auteur
Anita Asgar
  • Fonction : Auteur
Chawannuch Ruaengsri
  • Fonction : Auteur
Lin Wang
  • Fonction : Auteur
Lionel Leroux
  • Fonction : Auteur
Michele Flagiello
Muhanad Algadheeb
  • Fonction : Auteur
Paul Werner
Antonio Bartorelli
  • Fonction : Auteur
Nicholas Dumonteil
  • Fonction : Auteur
Arnar Geirsson
  • Fonction : Auteur
Francesco Massi
  • Fonction : Auteur
Moritz Wyler von Ballmoos
  • Fonction : Auteur
Sachin Goel
Michael Reardon
  • Fonction : Auteur
Vinayak Bapat
  • Fonction : Auteur
Tamim Nazif
  • Fonction : Auteur
Tsuyoshi Kaneko
  • Fonction : Auteur
Thomas Modine
Paolo Denti
  • Fonction : Auteur
Gilbert Tang
  • Fonction : Auteur
Gilbert H.L. Tang

Résumé

Background: Although >150,000 mitral TEER procedures have been performed worldwide, the impact of MR etiology on MV surgery after TEER remains unknown. Objectives: The authors sought to compare outcomes of mitral valve (MV) surgery after failed transcatheter edge-to-edge repair (TEER) stratified by mitral regurgitation (MR) etiology. Methods: Data from the CUTTING-EDGE registry were retrospectively analyzed. Surgeries were stratified by MR etiology: primary (PMR) and secondary (SMR). MVARC (Mitral Valve Academic Research Consortium) outcomes at 30 days and 1 year were evaluated. Median follow-up was 9.1 months (IQR: 1.1-25.8 months) after surgery. Results: From July 2009 to July 2020, 330 patients underwent MV surgery after TEER, of which 47% had PMR and 53.0% had SMR. Mean age was 73.8 ± 10.1 years, median STS risk at initial TEER was 4.0% (IQR: 2.2%-7.3%). Compared with PMR, SMR had a higher EuroSCORE, more comorbidities, lower LVEF pre-TEER and presurgery (all P < 0.05). SMR patients had more aborted TEER (25.7% vs 16.3%; P = 0.043), more surgery for mitral stenosis after TEER (19.4% vs 9.0%; P = 0.008), and fewer MV repairs (4.0% vs 11.0%; P = 0.019). Thirty-day mortality was numerically higher in SMR (20.4% vs 12.7%; P = 0.072), with an observed-to-expected ratio of 3.6 (95% CI: 1.9-5.3) overall, 2.6 (95% CI: 1.2-4.0) in PMR, and 4.6 (95% CI: 2.6-6.6) in SMR. SMR had significantly higher 1-year mortality (38.3% vs 23.2%; P = 0.019). On Kaplan-Meier analysis, the actuarial estimates of cumulative survival were significantly lower in SMR at 1 and 3 years. Conclusions: The risk of MV surgery after TEER is nontrivial, with higher mortality after surgery, especially in SMR patients. These findings provide valuable data for further research to improve these outcomes.
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Dates et versions

hal-04117203 , version 1 (05-06-2023)

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Citer

Syed Zaid, Marisa Avvedimento, Keti Vitanova, Serdar Akansel, Oliver Bhadra, et al.. Impact of Mitral Regurgitation Etiology on Mitral Surgery After Transcatheter Edge-to-Edge Repair. JACC: Cardiovascular Interventions, 2023, 16 (10), pp.1176-1188. ⟨10.1016/j.jcin.2023.02.029⟩. ⟨hal-04117203⟩
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