Key result
Patients undergoing transcatheter edge-to-edge mitral valve repair in the most recent quintile had significantly lower surgical risk compared to the first quintile (Euro Score II 7.2% vs. 10.9%, p<0.001).
Why the study?
The study sought to determine potential changes in baseline characteristic trends of patients with symptomatic severe mitral regurgitation undergoing M-TEER over the last decade in a high-volume center.
Observational (n=942)
No
Absolute Event Rate: 7.2% vs 10.9%
p-value: p=<0.001
Over a decade, patients undergoing M-TEER have presented with lower surgical risk and are treated earlier in their disease course, with reduced procedural and hospitalization times but unchanged short-term outcomes.
Objective This study sought to determine the potential change in trends in the baseline characteristics of patients with symptomatic severe mitral regurgitation who underwent transcatheter edge-to-edge mitral valve repair (M-TEER) over the last decade in a high-volume center. Methodology The investigation included 942 symptomatic patients with moderate-to-severe and severe mitral regurgitation who underwent transcatheter edge-to-edge repair (TEER) at our institution between January 2010 and March 2021. Patients were divided into quintiles and compared separately. Results Patients treated in the last quintile had significantly lower surgical risk (Euro Score 7.2 ± 6.8% in the last quintile vs. 10.9 ± 9.4% in the first quintile, p < 0.001), better New York Heart Association (NYHA) status (NYHA IV 14% in the last quintile vs. 40% in the first quintile, p < 0.001), lower NT-pro-BNP, and smaller left ventricle diameter than patients who were treated in the first quintile. There was no difference in age between quintiles. However, an invasive hemodynamic assessment did not show significant changes over the last decade (sPAP 51.35 ± 16.2 mmHg in the first quintile vs. 51.02 ± 14.5 mmHg in the last quintile, p = 0.90, pulmonary capillary wedge V wave 30.7 ± 14.8 mmHg in the first quintile vs. 27.4 ± 10.3 mmHg in the last quintile, p = 0.40). There is a significant trend of a gradually increasing proportion of patients with degenerative mitral regurgitation (MR) over the last 10 years (p < 0.001). The experience gained in the M-TEER procedure brought a significant reduction in fluoroscopy time and hospitalization duration. Medical therapy significantly changed over the last decade in terms of higher use of angiotensin receptor blockers (ARBs), lower use of angiotensin-converting enzyme inhibitors (ACEIs), and the introduction of angiotensin receptor-neprilysin inhibitors (ARNIs). Conclusion Patients undergoing the M-TEER procedure nowadays have lower surgical risk and are treated before they develop a significant left ventricular (LV) remodeling than before. The increasing expertise on the procedure over the last decade led to a rising number of patients with complex degenerative pathology being treated.
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Nita et al. (2022) conducted an observational in Symptomatic moderate-to-severe and severe mitral regurgitation (n=942). Transcatheter edge-to-edge mitral valve repair (M-TEER) over time vs. First quintile of patients (initial experience) was evaluated on Euro Score II (surgical risk) (p=<0.001). Patients undergoing transcatheter edge-to-edge mitral valve repair in the most recent quintile had significantly lower surgical risk compared to the first quintile (Euro Score II 7.2% vs. 10.9%, p<0.001).
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