Surgery reduced late severe MR incidence to 2.53 events per 100 person-years compared to 6.66 for TEER, indicating superior long-term outcomes for surgical repair.
Does surgical repair reduce the incidence of late severe MR compared to transcatheter edge-to-edge repair in patients with atrial functional mitral regurgitation?
In a meta-analysis of patients with atrial functional mitral regurgitation, surgical repair was associated with better long-term outcomes, including reduced late severe MR and heart failure hospitalization, compared to TEER, though TEER patients had significantly higher baseline risk.
Absolute Event Rate: 0% vs 0%
Abstract OBJECTIVES Atrial functional mitral regurgitation (MR) lacks well-defined treatment guidelines. Medical therapy alone is insufficient, and either TEER (transcatheter edge-to-edge) or surgery is recommended. Short- and long-term comparative outcomes remain unclear. We aim to address this gap using available data. METHODS We performed a meta-analysis of studies examining the outcomes of surgery and/or transcatheter edge-to-edge. MEDLINE, EMBASE, and the Cochrane Library were assessed. The incidence rate of late severe MR was the primary outcome. A random model was performed. Leave-one-out, subgroup, and meta-regression analyses were conducted. RESULTS Thirty-two studies (1923 patients); 20 in surgery (1166) vs 12 in TEER (757), were selected. TEER patients were, on average, 10 years older, with twice the rate of New York Heart Association Classification (NYHA) III/IV symptoms and more than double the Society of Thoracic Surgeons Risk (STS) score. At a weighted mean follow-up of 3.2 years, compared to isolated transcatheter, surgery was associated with decreased incidence of late severe MR (2.53 vs 6.66 events per 100 person-years, P-interaction = .03), late all-cause mortality (3.00 vs 8.84, P-interaction = .024), late heart failure hospitalization (4.44 vs 17.03, P-interaction .01), and late NYHA III/IV (2.98 vs 22.47, P-interaction .01). However, significantly better long-term outcomes associated with surgery showed high heterogeneity. There were no differences in early all-cause mortality, early cardiac-specific mortality, late cardiac-specific mortality, postprocedural morbidities, or atrial diameter. On meta-regression, preprocedural heart failure (β = 0.0224, P .01) and coronary artery disease (β = 0.0294, P .00001) were linked to increased late severe MR. Older age, hypertension, mitral valve replacement, and associated aortic valve surgery were linked to increased late all-cause mortality. CONCLUSIONS Surgery and isolated transcatheter edge-to-edge repair showed comparable short-term outcomes, with surgery appearing more effective long-term; however, due to study limitations and heterogeneity, these findings are hypothesis-generating and require validation through prospective studies. CLINICAL REGISTRATION NUMBER PROSPERO website: CRD42024504022.
Khairallah et al. (Tue,) reported a other. Surgery reduced late severe MR incidence to 2.53 events per 100 person-years compared to 6.66 for TEER, indicating superior long-term outcomes for surgical repair.