Transcatheter Mitral Valve Implantation Compared to Surgery: One-Year Clinical Outcome

Hendrik Ruge; Melchior Burri; Magdalena Erlebach; Stephanie S. Voss; Nazan Puluca; Caterina Campanella; Felix Wirth; Erion Xhepa; Andreas Stein; Markus Krane

doi:10.1055/a-2650-7092

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg
DOI: 10.1055/a-2650-7092

Original Cardiovascular

Transcatheter Mitral Valve Implantation Compared to Surgery: One-Year Clinical Outcome

Hendrik Ruge

¹Department of Cardiovascular Surgery, Institute Insure, German Heart Centre Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany

,

Melchior Burri

¹Department of Cardiovascular Surgery, Institute Insure, German Heart Centre Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany

,

Magdalena Erlebach

¹Department of Cardiovascular Surgery, Institute Insure, German Heart Centre Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany

,

Stephanie S. Voss

¹Department of Cardiovascular Surgery, Institute Insure, German Heart Centre Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany

,

Nazan Puluca

¹Department of Cardiovascular Surgery, Institute Insure, German Heart Centre Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany

,

Caterina Campanella

¹Department of Cardiovascular Surgery, Institute Insure, German Heart Centre Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany

,

Felix Wirth

¹Department of Cardiovascular Surgery, Institute Insure, German Heart Centre Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany

,

Erion Xhepa

²Department of Cardiology, German Heart Centre Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany

,

Andreas Stein

³Department of Anaesthesiology, German Heart Centre Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany

,

Markus Krane

¹Department of Cardiovascular Surgery, Institute Insure, German Heart Centre Munich, School of Medicine and Health, Technical University of Munich, Munich, Germany

⁴German Centre for Cardiovascular Research (DZHK)-Partner Site Munich Heart Alliance, Munich, Germany

› Author Affiliations

Abstract

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Abstract

Background

Transcatheter mitral valve implantation (TMVI) is an evolving technology, expanding therapeutic options for patients at higher operative risk. Data comparing TMVI to surgical mitral valve replacement (SMVR) are lacking.

Methods

Clinical outcomes after TMVI with the Tendyne mitral valve and SMVR were compared utilizing propensity score matching, including seven variables. The current study reports 1-year clinical outcomes after TMVI and 1-year mortality in both cohorts.

Results

Forty TMVI patients were compared to 80 SMVR patients. Baseline characteristics included in the matching protocol were well balanced: Age (78 years [interquartile range, IQR 75; 80] vs. 78 years [IQR 73; 80], p = 0.797), female sex (60% vs. 60% [p = 1.0]), atrial fibrillation (68% vs. 64% [p = 0.839]), previous coronary artery bypass grafting (CABG) or surgical aortic valve replacement (25% vs. 25% [p = 1.0]), body mass index (kg/m²; 26 ± 4 vs. 25 ± 4 [p = 0.723]), mitral valve pathology (regurgitation 70% vs. 74%, stenosis 7.5% vs. 4%, and mixed disease 22.5% vs. 23% [p = 0.649]), and concomitant tricuspid regurgitation (35% vs. 30% [p = 0.678]). Thirty-day mortality was similar in both groups (TMVI, n = 1, 2.5%; SMVR, n = 3, 3.75%, p = 0.47). Kaplan–Meier estimated survival at 1 year was comparable after TMVI (80 ± 6% [95% CI 69–93%]) and SMVR (86 ± 4% [95% CI 79–94%], p = 0.18) with seven additional deaths beyond 30 days in the TMVI group and eight in the SMVR group. In the TMVI group, two were non-cardiovascular deaths for encephalitis and sepsis after hip replacement, and five were cardiovascular deaths. In the SMVR group, one patient died due to intestinal ischemia, and in seven patients, the cause of death is unknown. At 1 year, in all TMVI patients, echocardiography showed ≤mild paravalvular regurgitation. Within 1 year after TMVI, 21 patients (52.5%) required rehospitalization for heart failure symptoms.

Conclusion

TMVI and SMVR in a propensity score-matched cohort displaying an intermediate surgical risk resulted in similar 1-year survival. TMVI achieved a sustained MR elimination at 1 year, and 80% of patients presented in the New York Heart Association (NYHA) class I or II.

Keywords

heart valve - transapical - percutaneous (TAVI) - mitral valve surgery

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References

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Supplementary Material

Supplementary Material