Outcomes of Mitral Valve Surgery after Edge-to-Edge Transcatheter Mitral Valve Repair: The Cutting-Edge Registry

Objectives: More 100,000 transcatheter edge-to-edge mitral valve Repair (TEER) has been performed worldwide in patients with severe mitral regurgitation (MR). However, multi-institutional longitudinal data on mitral valve surgery after TEER is lacking.

Methods: Data from the multicenter CUTTING-EDGE registry of patients who underwent mitral valve surgery after TEER were retrospectively reviewed. Surgeries were stratified by timing relative to TEER: aborted TEER cases (aborted), index TEER admission (acute), and separate admission (Delayed). Valve Academic Research Consortium-2 outcomes at 30 days and 1 year were evaluated. Median follow-up was 22.9 months from TEER.

Result: From 7/2005 to 7/2020, a total of 154 patients across 14 centers with mean age of 73 ± 9.7 years were enrolled. Median STS risk at initial TEER was 5.0%, 50% were performed with the original MitraClip, with degenerative/mixed disease present in 63.6% of cases. Median interval from TEER to surgery was 4.8 months; 17.3% Aborted, 20.1% acute, and 62.6% Delayed. Surgical Indications included partial/total leaflet detachment (37.4%), recurrent MR (35.7%), residual MR (24.7%) and mitral stenosis (12.3%). Mitral valve replacement was performed in 90.8% of cases, while 9.2% had mitral valve repair, and 42.7% had concomitant tricuspid surgery. Mean cardiopulmonary bypass and cross-clamp times were 132.4 ± 54.3 and 86.3 ± 41.2 minutes. On Kaplan–Meier analysis, 30-day and 1-year mortality were 16.0 and 27.5%, respectively. When 30-day mortality was analyzed by timing, Aborted had higher mortality compared with Acute and Delayed (33.3 vs. 7.1 vs. 9.6%, p = 0.006).

Conclusion: In this CUTTING-EDGE global registry, the risk of mitral surgery after TEER is not trivial; nonetheless, it provides valuable data for further research to improve these outcomes.

Publikationsverlauf

Artikel online veröffentlicht:
19. Februar 2021