Percutaneous vs Surgical Repair of Mitral Valve Regurgitation: Single Institution Early and Midterm Outcomes

• Published in: Canadian journal of cardiology Vol. 29; no. 4; pp. 452 - 459
• Main Authors: Paranskaya, Liliya, MD, D'Ancona, Giuseppe, MD, PhD, Bozdag-Turan, Ilkay, MD, Akin, Ibrahim, MD, PhD, Kische, Stephan, MD, PhD, Turan, Gökmen R., MD, Rehders, Tim, MD, PhD, Schneider, Henrik, MD, PhD, Westphal, Bernd, MD, Birkemeyer, Ralf, MD, Nienaber, Christoph A., MD, PhD, Ince, Hüseyin, MD, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.04.2013
• Subjects: Aged; Aged, 80 and over; Cardiovascular; Echocardiography; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Male; Middle Aged; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - surgery; Mitral Valve Insufficiency - therapy; Odds Ratio; Retrospective Studies; Severity of Illness Index; Stroke Volume; Time Factors; Treatment Outcome
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2012.06.002

Abstract Background The objective of this study was to compare outcomes of surgical repair (SR) vs MitraClip (MC) implantation for severe mitral regurgitation (MR). Methods A retrospective analysis of patients treated within a single institution was performed. Patients had EuroSCORE [European System for Cardiac Operative Risk Evaluation] < 20%, left ventricular ejection fraction ≥45%, and grade 3+/4+ MR. Results Fifty patients (24 [48%] MC group, 26 [52%] SR group) with EuroSCORE 7.9 ± 5.6 were included. The MC group included 24 (48%) and the SR group 26 (52%) patients. Patients in the MC group had a significantly more complex comorbid profile ( P < 0.001). Successful MC placement was in 22 patients (91.7%) and SR in 26 (100%). At discharge, no patient had grade 3+/4+ MR. There were no in hospital or 30-day deaths. At follow-up (mean 526 ± 398 days), further mitral valve surgery was necessary in 1 (3.8%) patient in the SR group and in 2 (8.3%) patients in the MC group ( P = 0.26). One-year freedom from composite end point (death, stroke, myocardial infarction, major bleeding, cardiac rehospitalization) was 75.5% (SR 83% vs MC 67%; P = 0.18). Degree of residual MR Degree of residual MR immediately after the procedure was equally distributed in both groups ( P = 0.13) and the sole independent determinant for composite outcome (odds ratio, 16.9; P = 0.024). Conclusions MC in nonsurgical candidates and SR in surgical patients showed similar perioperative and follow-up outcomes at an institution experienced with both techniques. Neither MC nor SR were independently related to outcome whenever similar degrees of acute correction with minimal residual MR were achieved. However, these findings should be interpreted within the selection biases and the numerical limitations of the present study.