Thirty-day and one-year outcomes following transcatheter mitral valve edge-to-edge repair versus transapical mitral valve replacement in patients with left ventricular dysfunction

Hungerford, Sara and Bart, Nicole and Song, Ning and Jansz, Paul and Dahle, Gry and Duncan, Alison and Hayward, Christopher and Muller, David (2023) Thirty-day and one-year outcomes following transcatheter mitral valve edge-to-edge repair versus transapical mitral valve replacement in patients with left ventricular dysfunction. AsiaIntervention, 9 (1). pp.78-86. ISSN 2426-3958

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Link to published document: http://doi.org/10.4244/AIJ-D-22-00049

Abstract

BACKGROUND: A comparison of 30-day and 1-year clinical outcomes in patients with pre-existing left ventricular (LV) dysfunction undergoing transcatheter mitral valve edge-to-edge repair (TEER) or transcatheter transapical mitral valve replacement (TMVR) has not previously been reported. AIMS: We aimed to compare 30-day and 1-year rates of all-cause and cardiovascular mortality as well as rehospitalisation for heart failure (HFH). METHODS: All patients with severe (>/=3+) symptomatic mitral regurgitation (MR) and an LV ejection fraction </=50% who underwent TEER or TMVR over a 5-year period were evaluated. RESULTS: Ninety-six patients (50 TEER, age 80+/-9 years, 70% secondary MR and 46 TMVR, age 72+/-9 years, 91% secondary MR) were studied. Baseline demographic and transthoracic echocardiogram characteristics were well-matched, with the exception of age (TEER 80+/-9 vs TMVR 72+/-9; p=0.01). Successful device implantation occurred in 96% of TEER patients and 97.8% of TMVR patients. Ninety-two percent of TEER patients had </=2+MR predischarge, whilst no TMVR patient had >/=1+MR (p<0.01). No significant difference in the combined endpoint of 30-day all-cause mortality or HFH was observed (p>0.05). At 1 year, freedom from all-cause mortality and HFH was 79.2% across the entire study population but was significantly higher in patients undergoing TEER (TEER: n=45 [90%] hazard ratio 11.26, 95% confidence interval [CI]: 10.59-11.93 vs TMVR: n=39 [67.4%] 95% CI: 10.09-11.33; p=0.008). CONCLUSIONS: Despite comparable rates of successful device implantation, MR reduction, and 30-day all-cause mortality/HFH, TEER patients had lower all-cause mortality and HFH rates at 1 year.

Item Type: Article
Subjects: R Medicine > R Medicine (General)
Depositing User: Repository Administrator
Date Deposited: 27 Apr 2023 04:36
Last Modified: 27 Apr 2023 04:36
URI: http://eprints.victorchang.edu.au/id/eprint/1381

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