OBJECTIVES The aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). BACKGROUND Although >100,000 mitral TEER procedures have been performed worldwide, longitudinal data on MV surgery after TEER are lacking. METHODS Data from the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 9.0 months (interquartile range [IQR]: 1.2-25.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year. RESULTS From July 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. The mean age was 73.8 +/- 10.1 years, median Society of Thoracic Surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. The median in-terval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median Society of Thoracic Surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. The 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. On Kaplan-Meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery. CONCLUSIONS In this first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only <10% of patients underwent MV repair. These registry data provide valuable insights for further research to improve these outcomes. (J Am Coll Cardiol Intv 2021;14:2010-2021) (c) 2021 by the American College of Cardiology Foundation.
Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair / Kaneko, Tsuyoshi; Hirji, Sameer; Zaid, Syed; Lange, Rudiger; Kempfert, Jörg; Conradi, Lenard; Hagl, Christian; Borger, Michael A.; Taramasso, Maurizio; Nguyen, Tom C.; Ailawadi, Gorav; Shah, Ashish S.; Smith, Robert L.; Anselmi, Amedeo; Romano, Matthew A.; Ben Ali, Walid; Ramlawi, Basel; Grubb, Kendra J.; Robinson, Newell B.; Pirelli, Luigi; Chu, Michael W. A.; Andreas, Martin; Obadia, Jean-Francois; Gennari, Marco; Garatti, Andrea; Tchetche, Didier; Nazif, Tamim M.; Bapat, Vinayak N.; Modine, Thomas; Denti, Paolo; Tang, Gilbert H. L.; Vitanova, Keti; Krane, Markus; Akansel, Serdar; Bhadra, Oliver D.; Saha, Shekhar; Bagaev, Erik; Noack, Thilo; Fahr, Florian; Ascione, Guido; Tagliari, Ana Paula; Pizano, Alejandro; Donatelle, Marissa; Goel, Kashish; Squiers, John J.; Shah, Pinak B.; Leurent, Guillaume; Corbineau, Herve; Asgar, Anita W.; Demers, Philippe; Pellerin, Michel; Bouchard, Denis; Ruaengsri, Chawannuch; Wang, Lin; Petrossian, George A.; Kliger, Chad A.; Leroux, Lionel; Algadheeb, Muhanad; Lavi, Shahar; Werner, Paul; Flagiello, Michele; Bartorelli, Antonio L.; Ghattas, Angie; Dumonteil, Nicholas; von Ballmoos, Moritz Wyler; Atkins, Marvin D.; D'Onofrio, Augusto; Tessari, Chiara; Geirsson, Arnar; Kaple, Ryan K.; Massi, Francesco; Triggiani, Michele; Van Belle, Eric; Vincent, Flavien; Denimal, Tom; Brinkmann, Christina; Schöfer, Joachim; Di Eusanio, Marco; Capestro, Filippo; Estevez-Loureiro, Rodrigo; Pinon, Miguel A.; Kleiman, Neal S.; Reardon, Michael J.; Szerlip, Molly I.; Dimaio, J. Michael; Mack, Michael J.; Lim, D. Scott; Falk, Volkmar; Maisano, Francesco; George, Isaac; Hahn, Rebecca T.. - In: JACC: CARDIOVASCULAR INTERVENTIONS. - ISSN 1936-8798. - 14:18(2021), pp. 2010-2021. [10.1016/j.jcin.2021.07.029]
Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair
Gennari, Marco;Massi, Francesco;Di Eusanio, Marco;Capestro, Filippo;
2021-01-01
Abstract
OBJECTIVES The aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). BACKGROUND Although >100,000 mitral TEER procedures have been performed worldwide, longitudinal data on MV surgery after TEER are lacking. METHODS Data from the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 9.0 months (interquartile range [IQR]: 1.2-25.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year. RESULTS From July 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. The mean age was 73.8 +/- 10.1 years, median Society of Thoracic Surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. The median in-terval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median Society of Thoracic Surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. The 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. On Kaplan-Meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery. CONCLUSIONS In this first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only <10% of patients underwent MV repair. These registry data provide valuable insights for further research to improve these outcomes. (J Am Coll Cardiol Intv 2021;14:2010-2021) (c) 2021 by the American College of Cardiology Foundation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
