Post-procedural in-hospital, short and long-term outcomes of transcatheter (percutaneous) versus surgical approach for management of patients with non-rheumatic mitral valve stenosis

Background Non-rheumatic mitral valve stenosis (NRMS), has emerged as a growing clinical challenge in aging populations. Despite its increasing prevalence, patients with severe NRMS face limited treatment options due to extensive annular calcification and high surgical risk. While both surgical and transcatheter interventions have been employed for NRMS, each approach presents unique challenges. Methods (1-9). We conducted a retrospective, population-based cohort study using data from the California and New York State large discharge databases from January 2016 to December 2022. The study population included adults (≥18 years) diagnosed with non-rheumatic mitral valve stenosis who underwent isolated surgical or transcatheter mitral valve replacement. The primary outcome was a composite of all-cause mortality, stroke, hospitalization for heart failure and re-intervention. Secondary outcomes included post-procedural in-hospital complications and hospitalization rates for heart failure. Results A total of 662 patients met the inclusion criteria, with 147 underwent transcatheter mitral valve replacement (TMVR) and 515 surgical mitral valve replacement (SMVR). At four years, the incidence of the composite primary outcome was higher in the TMVR group compared to the SMVR group (59.66% vs. 42.24%; HR 1.31, 95% CI 0.97–1.76, P=0.074). TMVR was associated with significantly higher rates of heart failure (CHF) hospitalizations (rate ratio 1.81, 95% CI 1.09–2.99, P=0.021). In-hospital outcomes demonstrated a lower incidence of acute kidney injury (AKI) (OR 0.30, P<0.001), atrial fibrillation (OR 0.17, P<0.001), atrioventricular block (OR 0.31, P=0.017), and pacemaker placement (OR 0.12, P=0.004) in the TMVR group compared to SMVR. Rates of stroke, major bleeding, and ventricular arrhythmias did not differ significantly between groups. After propensity matching (141 pairs), TMVR remained associated with a higher four-year incidence of the composite outcome, and now statistically significant (60.48% vs. 45.96%; HR 1.50, 95% CI 1.04 2.15, P=0.028). However, the difference in CHF hospitalization rates was no longer statistically significant (rate ratio 2.22, 95% CI 0.87 5.63, P=0.094). In-hospital differences persisted, with TMVR patients having lower odds of AKI (OR 0.33, P<0.001), CHF (OR 0.31, P=0.002), and atrial fibrillation (OR 0.23, P=0.001), while no significant differences were observed in stroke, major bleeding, ventricular arrhythmias, or atrioventricular block. Pacemaker placement remained significantly lower in the TMVR group (OR 0.10, P=0.003). Conclusions Transcatheter mitral valve replacement (TMVR) was associated with fewer peri-procedural complications compared to surgical mitral valve replacement (SMVR), including lower rates of acute kidney injury, atrial fibrillation, and pacemaker implantation. However, TMVR was linked to a higher long-term incidence of adverse cardiovascular outcomes, including an increased composite outcome risk.