Surgical Mitral Valve Repair vs Replacement After Failed Mitral Transcatheter Edge-to-Edge Repair: The CUTTING-EDGE Registry.

Marin-Cuartas, Mateo; Kang, Jagdip; Noack, Thilo; de la Cuesta, Manuela; Krane, Markus; Falk, Volkmar; Conradi, Lenard; Hagl, Christian; Taramasso, Maurizio; Nguyen, Tom C; Lim, D Scott; Ailawadi, Gorav; Mack, Michael J; Smith, Robert L; Asgar, Anita W; Grubb, Kendra J; Pirelli, Luigi; Denti, Paolo; Modine, Thomas; Reardon, Michael J; Nazif, Tamim M; Bapat, Vinayak N; Kaneko, Tsuyoshi; Kiefer, Philipp; Borger, Michael A; Tang, Gilbert H L; Zaid, Syed

doi:10.1016/j.jcin.2025.02.008

journal article

Titel:: Surgical Mitral Valve Repair vs Replacement After Failed Mitral Transcatheter Edge-to-Edge Repair: The CUTTING-EDGE Registry.
Dokumenttyp:: Journal Article; Multicenter Study; Comparative Study
Autor(en):: Marin-Cuartas, Mateo; Kang, Jagdip; Noack, Thilo; de la Cuesta, Manuela; Krane, Markus; Falk, Volkmar; Conradi, Lenard; Hagl, Christian; Taramasso, Maurizio; Nguyen, Tom C; Lim, D Scott; Ailawadi, Gorav; Mack, Michael J; Smith, Robert L; Asgar, Anita W; Grubb, Kendra J; Pirelli, Luigi; Denti, Paolo; Modine, Thomas; Reardon, Michael J; Nazif, Tamim M; Bapat, Vinayak N; Kaneko, Tsuyoshi; Kiefer, Philipp; Borger, Michael A; Tang, Gilbert H L; Zaid, Syed
Abstract:: BACKGROUND: The impact of mitral valve (MV) surgery type after failed mitral transcatheter edge-to-edge repair (M-TEER) has not been well studied. OBJECTIVES: The aim of this study was to compare the outcomes of MV repair vs replacement after failed M-TEER. METHODS: From 2009 to 2020, a total of 332 patients across 34 centers from the CUTTING-EDGE registry underwent MV surgery after M-TEER. Outcomes were compared between MV repair and replacement. Primary outcomes included 30-day mortality and 1-year survival after MV surgery. RESULTS: Among enrolled patients (mean age 73.8 ± 10.1 years, median Society of Thoracic Surgeons Predicted Risk of Mortality 3.9% [Q1-Q3: 2.2%-6.8%]), 25 (7.5%) underwent repair and 307 (92.5%) underwent replacement. The replacement group had a significantly higher rate of comorbidities, including atrial fibrillation, prior cardiac surgery, more secondary mitral regurgitation, and more devices implanted at index M-TEER (P < 0.05 for all). Replacement patients showed a trend toward higher 30-day mortality (17.7% [52 of 294] vs 4.0% [1 of 25]; P = 0.094). The observed-to-expected ratio of 30-day mortality was 3.6 (95% CI: 1.9-5.3) overall, 3.8 (95% CI: 2.1-5.5) in the replacement group, and 1.7 (95% CI: 0.7-3.3) in the repair group. Replacement patients had higher 1-year mortality (33.3% [65 of 195] vs 10.5% [2 of 19]; P = 0.041). Significantly lower survival rates were observed after replacement at 2 years (P = 0.033) and persisted in the risk-adjusted Cox regression analysis (HR for replacement: 4.24; 95% CI: 1.04-17.31; P = 0.044). CONCLUSIONS: MV surgery after failed M-TEER is a high-risk procedure associated with higher than expected 30-day mortality, with higher mortality associated with MV replacement. Compared with repair, replacement is associated with higher 1-year mortality and a lower 2-year survival.
Zeitschriftentitel:: JACC Cardiovasc Interv
Jahr:: 2025
Band / Volume:: 18
Heft / Issue:: 7
Seitenangaben Beitrag:: 912-923
Volltext / DOI:: doi:10.1016/j.jcin.2025.02.008
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/40240085
Print-ISSN:: 1936-8798
TUM Einrichtung:: 592; Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)2025