For functional mitral regurgitation, randomized clinical trials showed that transcatheter edge-to-edge repair (TEER) was more effective than medical care in improving outcomes; however, there were few randomized data for degenerative mitral regurgitation (DMR). For a study, the researchers sought to compare the effects of elderly patients treated with TEER versus DMR that had not been operated on. The research looked at registries with patients aged more than or equal to 65 and up who had symptomatic severe DMR and were either treated with TEER (MitraSwiss and Minneapolis Heart Institute registries) or left untreated (MIDA registry). Age, sex, EuroSCORE II, and ejection fraction were all considered when comparing survival. There were 1,187 patients in the research (872 treated with TEER and 315 unoperated). 430 individuals died between 24 and 17 months of follow-up, with somewhere between 18 and 1% dying after a year and somewhere between 50 and 2% dying after 4 years. Patients who underwent TEER were similar in age and sex to unoperated patients (82±6 vs 82±7 years) but had higher surgical risk/comorbidity (EuroSCORE II 3.98±4.28% vs 2.77±2.46%), more symptoms, and atrial fibrillation (P<0.0001). Researchers took age, sex, EuroSCORE II, New York Heart Association class, atrial fibrillation, and ejection fraction into consideration, transcatheter edge-to-edge repair was related with decreased mortality [hazard ratio (HR): 0.47, 955 confidence interval (CI): 0.37–0.58; P<0.0001]. Even in thorough multivariable analysis (HR: 0.60, 95% CI: 0.40–0.91; P=0.03), TEER persistently showed superior survival compared to unoperated patients (49±6% vs 37±3% at 4 years, P <0.0001). Although the procedural failure was uncommon, post-procedural mitral regurgitation, which remained moderate to severe in 66 (7.6%) patients, was linked to an increased risk of death compared to trivial residual regurgitation (30 ± 6% vs 11 ± 1% at 1 year, P<0.0001). Mitral TEER was related to improved survival than unoperated individuals in older patients with severe symptomatic DMR at high surgical risk. Mitral TEER improved survival by successfully controlling mitral regurgitation, and it should have been actively considered in patients who were thought inoperable.

 

Link:academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehab910/6516827?redirectedFrom=fulltext