Key result
Percutaneous mitral valve repair was identified as a risk factor for cardiac death at 3 years compared to surgical repair (HR 0.19; 95% CI 0.040-0.86; P=0.031).
Why the study?
Outcomes comparing surgical mitral valve repair or replacement with percutaneous edge-to-edge repair using MitraClip in patients with functional mitral regurgitation and severe left ventricular dysfunction required evaluation.
Does percutaneous edge-to-edge repair using MitraClip improve outcomes compared to surgical mitral valve repair or replacement in patients with functional mitral regurgitation and LVEF ≤ 30%?
Cohort (n=132)
No
Does percutaneous edge-to-edge repair using MitraClip improve outcomes compared to surgical mitral valve repair or replacement in patients with functional mitral regurgitation and LVEF ≤ 30%?
Hazard Ratio: 0.19 (95% CI 0.04–0.86)
p-value: p=0.031
In patients with severe LV dysfunction and functional MR, MitraClip offers lower perioperative risk but surgery may provide better long-term survival and lower heart failure re-hospitalization rates for those who survive the perioperative period.
May warrant caution with percutaneous repair for long-term survival in severe LV dysfunction; leaves open randomized confirmation.
AIMS: The aim of this study was to compare the outcomes of surgical mitral valve repair or replacement (sMVR) and percutaneous edge-to-edge repair using MitraClip (pMVR) in patients with severe left ventricular dysfunction affected by functional mitral regurgitation (FMR). METHODS AND RESULTS: We retrospectively identified 132 patients with left ventricular ejection fraction (LVEF) ≦ 30% submitted to sMVR (n = 47) or pMVR (n = 85) for FMR at our centre from January 2013 to December 2017. To adjust for baseline imbalances, we used a propensity score matching by age, logistic EuroSCORE, and left ventricular end-systolic volume. After being matched, MitraClip therapy showed lower perioperative mortality and rate of complications yet increased residual mitral regurgitation (MR) grade than did surgery (0.2 ± 0.50 in sMVR vs. 1.3 ± 0.88 in pMVR, P < 0.0001). According to stratified multivariate Cox model analysis, residual MR severity was an independent risk factor for cardiac death [hazard ratio (HR), 2.81; 95% confidence interval [CI], 1.44-5.48, P = 0.0025] and re-hospitalization for heart failure (HR, 3.07; 95% CI, 1.50-6.29, P = 0.0022) at 1 year follow-up. Stratified multivariable Cox regression analysis at 3 years identified pMVR as risk factor for cardiac death (HR, 0.19; 95% CI, 0.040-0.86, P = 0.031) and re-hospitalization for heart failure (HR, 0.28; 95% CI, 0.077-0.99, P = 0.048). CONCLUSIONS: In patients with FMR and LVEF ≤ 30%, MitraClip therapy resulted in lower perioperative complications and mortality than sMVR. However, surgically treated patients who survived the perioperative stage had less residual MR and experienced lower rates of re-hospitalization for heart failure at 1 year and lower cardiac mortality at 1 and 3 years of follow-up than did patients undergoing pMVR.
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Gyoten et al. (2020) conducted a cohort in Severe left ventricular dysfunction affected by functional mitral regurgitation (FMR) (n=132). Percutaneous edge-to-edge repair using MitraClip (pMVR) vs. Surgical mitral valve repair or replacement (sMVR) was evaluated on Cardiac death at 3 years (HR 0.19, 95% CI 0.040-0.86, p=0.031). Percutaneous mitral valve repair was identified as a risk factor for cardiac death at 3 years compared to surgical repair (HR 0.19; 95% CI 0.040-0.86; P=0.031).
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