Transcatheter Mitral Valve Replacement or Repair for Secondary Mitral Regurgitation: A Propensity Score-Matched Analysis
Key result
TMVR is linked to superior MR reduction vs M-TEER but similar 1-year mortality.
- P=0.056
- n=1,327
Why the study?
Outcomes after transcatheter mitral valve replacement and mitral valve transcatheter edge-to-edge repair for secondary mitral regurgitation have not been directly compared in propensity score-matched cohorts.
Does transcatheter mitral valve replacement improve clinical and echocardiographic outcomes compared to transcatheter edge-to-edge repair in patients with secondary mitral regurgitation?
Comparison
Transcatheter mitral valve replacement vs mitral valve transcatheter edge-to-edge repair
Design
Propensity score-matched cohort analysis from registries
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
TMVR should not yet change mitral intervention practice; leaves open comparative effectiveness versus M-TEER in randomized trials.
Key Points
- To compare clinical, functional, and echocardiographic outcomes up to one year between transcatheter mitral valve replacement (TMVR) and transcatheter edge-to-edge repair (M-TEER) in secondary mitral regurgitation.
- Propensity score matching for 12 demographic, clinical, and echocardiographic variables was performed using the CHOICE-MI (N=262 TMVR) and EuroSMR (N=1065 M-TEER) registries.
- The matched cohort compared 235 TMVR patients (median age 75.5 years, EuroSCORE II 6.3%) to 411 M-TEER patients (median age 76.7 years, EuroSCORE II 6.7%) through 1 year of follow-up.
- All-cause mortality was 6.8% for TMVR versus 3.8% for M-TEER at 30 days (p=0.11) and 25.8% versus 18.9% at 1 year (p=0.056), with no significant difference beyond 30 days in a landmark analysis (20.4% vs. 15.8%, p=0.21).
- TMVR produced more effective regurgitation elimination, with residual mitral regurgitation ≤1+ at hospital discharge achieved in 95.8% of TMVR patients versus 68.8% of M-TEER patients (p<0.001).
- Symptom relief was superior in the TMVR group, with 77.8% achieving New York Heart Association class ≤II at 1 year compared to 64.3% in the M-TEER group (p=0.015).
Study Design
Type
Cohort (n=1,327)
Multicenter
Yes
Structured PICO
Does transcatheter mitral valve replacement improve clinical and echocardiographic outcomes compared to transcatheter edge-to-edge repair in patients with secondary mitral regurgitation?
P
Population
1,327 patients (646 propensity-matched) with secondary mitral regurgitation treated with transcatheter mitral valve replacement or edge-to-edge repair, followed for up to 1 year.
E
Exposure
Transcatheter mitral valve replacement (TMVR)
C
Comparator
Mitral valve transcatheter edge-to-edge repair (M-TEER)
O
Outcome
Echocardiographic (residual MR), functional (NYHA class), and clinical outcomes (all-cause mortality) out to 1 yearhard clinical
Main Result
Absolute Event Rate: 25.8% vs 18.9%
p-value: p=0.056
In patients with secondary mitral regurgitation, TMVR provides superior MR reduction and symptomatic improvement compared to M-TEER, though with a trend toward higher early mortality.
Cite This Study
Ludwig et al. (2023) conducted a cohort in Secondary mitral regurgitation (n=1,327). Transcatheter mitral valve replacement (TMVR) vs. Mitral valve transcatheter edge-to-edge repair (M-TEER) was evaluated on All-cause mortality at 1 year (p=0.056). Transcatheter mitral valve replacement provided superior MR reduction (95.8% vs 68.8%, p<0.001) compared to M-TEER, with no significant difference in 1-year mortality (25.8% vs 18.9%, p=0.056).