Transcatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitation
Abstract Objectives Transcatheter edge-to-edge repair (TEER) is an alternative for patients with severe degenerative mitral regurgitation (MR). The objective of this study was to compare the outcomes of surgery and TEER in older patients with degenerative MR patients using real life data. Methods Co...
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| Format: | Article |
| Language: | English |
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BMC
2025-01-01
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| Series: | Journal of Cardiothoracic Surgery |
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| Online Access: | https://doi.org/10.1186/s13019-024-03257-x |
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| author | Gaspard Suc Rebecca Hadjedj Jules Mesnier Skerdi Haviari Marylou Para Gregory Ducrocq Dominique Himbert Eric Brochet My Lien Nguyen Sophie Provenchere Marina Urena Bernard Iung |
| author_facet | Gaspard Suc Rebecca Hadjedj Jules Mesnier Skerdi Haviari Marylou Para Gregory Ducrocq Dominique Himbert Eric Brochet My Lien Nguyen Sophie Provenchere Marina Urena Bernard Iung |
| author_sort | Gaspard Suc |
| collection | DOAJ |
| description | Abstract Objectives Transcatheter edge-to-edge repair (TEER) is an alternative for patients with severe degenerative mitral regurgitation (MR). The objective of this study was to compare the outcomes of surgery and TEER in older patients with degenerative MR patients using real life data. Methods Consecutives older patients (≥ 65 years-old), with severe symptomatic, degenerative MR requiring surgery or TEER between 2013 and 2023 were included. Exclusion criteria were secondary MR, and active endocarditis. Primary outcome was a composite of all-cause death, hospitalization for heart failure or mitral valve intervention within one year. Results A total of 295 patients were included (203 underwent surgery and 92 underwent TEER). At 1 year, 26 (9%) patients had died, required reintervention or rehospitalization for heart failure: 8 patients in the surgery group (4%) and 18(20%) in the TEER group(p < 0.01). Factors independently associated with the combined outcome were residual MR > 2 (aHR 4.31 (95% CI: 1.51–12.25)), history of cardiac surgery (aHR 6.24 (95%CI: 2.16–18.05)), BMI (aHR 0.88 (95% CI: 0.77–0.98)), TR > 2 at baseline (aHR: 2.47 (95% CI: 1.03–5.91)). After adjustement on confounding factors, intervention type was not associated with the primary composite outcome (aHR: 3.41 (95% CI: 0.63–18.27)), p = 0.15). Conclusion Patients with severe primary MR treated with TEER experienced a higher rate of adverse events within one year compared to surgically managed patients. However, these differences were mainly associated to clinical characteristics and were no longer significant after adjustment on residual MR > 2. Graphical Abstract |
| format | Article |
| id | doaj-art-de6e8de579d34213877109f49acc5ac7 |
| institution | Kabale University |
| issn | 1749-8090 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj-art-de6e8de579d34213877109f49acc5ac72025-01-19T12:38:13ZengBMCJournal of Cardiothoracic Surgery1749-80902025-01-012011910.1186/s13019-024-03257-xTranscatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitationGaspard Suc0Rebecca Hadjedj1Jules Mesnier2Skerdi Haviari3Marylou Para4Gregory Ducrocq5Dominique Himbert6Eric Brochet7My Lien Nguyen8Sophie Provenchere9Marina Urena10Bernard Iung11Cardiology Bichat, AP-HPCardiology Bichat, AP-HPCardiology Bichat, AP-HPUniversité Paris CitéCardiac Surgery, Bichat Hospital, AP-HPCardiology Bichat, AP-HPCardiology Bichat, AP-HPCardiology Bichat, AP-HPCardiology Bichat, AP-HPInserm CIC 1425, Bichat-Claude Bernard University Hospital, AP-HPCardiology Bichat, AP-HPCardiology Bichat, AP-HPAbstract Objectives Transcatheter edge-to-edge repair (TEER) is an alternative for patients with severe degenerative mitral regurgitation (MR). The objective of this study was to compare the outcomes of surgery and TEER in older patients with degenerative MR patients using real life data. Methods Consecutives older patients (≥ 65 years-old), with severe symptomatic, degenerative MR requiring surgery or TEER between 2013 and 2023 were included. Exclusion criteria were secondary MR, and active endocarditis. Primary outcome was a composite of all-cause death, hospitalization for heart failure or mitral valve intervention within one year. Results A total of 295 patients were included (203 underwent surgery and 92 underwent TEER). At 1 year, 26 (9%) patients had died, required reintervention or rehospitalization for heart failure: 8 patients in the surgery group (4%) and 18(20%) in the TEER group(p < 0.01). Factors independently associated with the combined outcome were residual MR > 2 (aHR 4.31 (95% CI: 1.51–12.25)), history of cardiac surgery (aHR 6.24 (95%CI: 2.16–18.05)), BMI (aHR 0.88 (95% CI: 0.77–0.98)), TR > 2 at baseline (aHR: 2.47 (95% CI: 1.03–5.91)). After adjustement on confounding factors, intervention type was not associated with the primary composite outcome (aHR: 3.41 (95% CI: 0.63–18.27)), p = 0.15). Conclusion Patients with severe primary MR treated with TEER experienced a higher rate of adverse events within one year compared to surgically managed patients. However, these differences were mainly associated to clinical characteristics and were no longer significant after adjustment on residual MR > 2. Graphical Abstracthttps://doi.org/10.1186/s13019-024-03257-xDegenerative valveMitral valve repairTransthoracic echocardiographyMitral regurgitation |
| spellingShingle | Gaspard Suc Rebecca Hadjedj Jules Mesnier Skerdi Haviari Marylou Para Gregory Ducrocq Dominique Himbert Eric Brochet My Lien Nguyen Sophie Provenchere Marina Urena Bernard Iung Transcatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitation Journal of Cardiothoracic Surgery Degenerative valve Mitral valve repair Transthoracic echocardiography Mitral regurgitation |
| title | Transcatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitation |
| title_full | Transcatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitation |
| title_fullStr | Transcatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitation |
| title_full_unstemmed | Transcatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitation |
| title_short | Transcatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitation |
| title_sort | transcatheter edge to edge compared with surgery in older patients with degenerative mitral valve regurgitation |
| topic | Degenerative valve Mitral valve repair Transthoracic echocardiography Mitral regurgitation |
| url | https://doi.org/10.1186/s13019-024-03257-x |
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