Two-Year Mitral Valve TEER Outcomes Among Patients With a History of Major Cardiac Surgery

A study found that mitral-valve transcatheter edge-to-edge repair (MV-TEER) was an effective therapy among patients who had previously undergone major cardiac surgery. These findings were published in Catheterization & Cardiovascular Interventions.

Data for this study were sourced from the single-arm, prospective Multicentre Italian Society of Interventional Cardiology registry of transcatheter treatment of mitral valve regurgitation (GIOTTO). Patients (N=330) who underwent coronary artery bypass grafting (CABG), aortic valve replacement (AVR), or mitral valve repair (MVR) and went on to receive MV-TEER since 2016 were evaluated for outcomes at 1 and 2 years. The primary outcome was the composite endpoint of death or rehospitalization.

The study population comprised 81.8% men, aged median 79.0 (IQR, 74.0-83.0) years, and average BMI was 25.1±3.7. The patients underwent CABG (n=257), AVR (n=47), and MVR (n=26). The MVR cohort was significantly younger (P <.001), less male (P =.004), fewer had New York Heart Association (NYHA) class III-IV (P =.004), and they tended to have fewer comorbidities overall.

Among the entire population, at 1 and 2 years the composite endpoint was reached by 29.1% and 52.4% of patients, respectively. At 1 year 13.8% died and 14.1% were rehospitalized. At year 2, 31.7% died and 23.5% were rehospitalized.

No significant group differences for the composite endpoint were observed on the basis of previous cardiac surgery (P =.928) nor on the basis of functional or degenerative mitral regurgitation (P =.850). Significant differences in the composite endpoint were observed for residual mitral regurgitation of less than 2+ vs 2+ or greater (P =.001) and NYHA class I-II vs III-IV (P =.034).

At 1 year, the composite endpoint was predicted in the univariate analysis by Euroscore II, NYHA class III-IV, chronic kidney disease, prior heart failure, prior myocardial infarction, coronary artery disease, high-dose furosemide, left ventricle (LV) end-diastolic volume, LV end-systolic volume, residual mitral regurgitation 2+, Mitral Valve Academic Research Consortium structural failure, and acute complications.

In the multivariate analysis, residual mitral regurgitation of 2+ or greater (hazard ratio [HR], 1.54; 95% CI, 1.00-2.38; P =.050) was a marginally significant predictor and NYHA class III-IV (HR, 1.90; 95% CI, 0.96-3.81; P =.067) was not a significant predictor for the composite outcome. No other predicters remained significant in the multivariate analysis.

The major limitations of this study were the small sample sizes overall and among subgroups.

The study authors wrote, “MV‐TEER is feasible and effective in high‐risk patients who previously underwent major cardiac surgery. No differences were evident in terms of clinical outcomes when patients were stratified according to the subtype of previous surgery and the MR etiology. A postprocedural residual [mitral regurgitation] grade of 2+ or greater appeared to be the strongest independent predictor of adverse outcomes at 1‐year follow‐up.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

De Felice F, Paolucci L, Musto C, et al. Clinical outcomes and predictors in patients with previous cardiac surgery undergoing mitral valve transcatheter edge‐to‐edge repair. Catheter Cardiovasc Interv. Published online May 29, 2022. doi:10.1002/ccd.30245