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Titel:

Transcatheter mitral valve replacement or repair for secondary mitral regurgitation: a propensity score-matched analysis.

Dokumenttyp:
Article; Journal Article; Research Support, Non-U.S. Gov't
Autor(en):
Ludwig, Sebastian; Kalbacher, Daniel; Ali, Walid Ben; Weimann, Jessica; Adam, Matti; Duncan, Alison; Webb, John G; Windecker, Stephan; Orban, Mathias; Giannini, Cristina; Coisne, Augustin; Karam, Nicole; Scotti, Andrea; Sondergaard, Lars; Adamo, Marianna; Muller, David W M; Butter, Christian; Denti, Paolo; Melica, Bruno; Regazzoli, Damiano; Garatti, Andrea; Schmidt, Tobias; Andreas, Martin; Dahle, Gry; Taramasso, Maurizio; Nickenig, Georg; Dumonteil, Nicolas; Walther, Thomas; Flagiello, Michele;...     »
Abstract:
AIMS: This study aimed to compare outcomes after transcatheter mitral valve replacement (TMVR) and mitral valve transcatheter edge-to-edge repair (M-TEER) for the treatment of secondary mitral regurgitation (SMR). METHODS AND RESULTS: The CHOICE-MI registry included 262 patients with SMR treated with TMVR between 2014 and 2022. The EuroSMR registry included 1065 patients with SMR treated with M-TEER between 2014 and 2019. Propensity score (PS) matching was performed for 12 demographic, clinical and echocardiographic parameters. Echocardiographic, functional and clinical outcomes out to 1 year were compared in the matched cohorts. After PS matching, 235 TMVR patients (75.5 years [70.0, 80.0], 60.2% male, EuroSCORE II 6.3% [interquartile range 3.8, 12.4]) were compared to 411 M-TEER patients (76.7 years [70.1, 80.5], 59.0% male, EuroSCORE II 6.7% [3.9, 12.4]). All-cause mortality was 6.8% after TMVR and 3.8% after M-TEER at 30 days (p = 0.11), and 25.8% after TMVR and 18.9% after M-TEER at 1 year (p = 0.056). No differences in mortality after 1 year were found between both groups in a 30-day landmark analysis (TMVR: 20.4%, M-TEER: 15.8%, p = 0.21). Compared to M-TEER, TMVR resulted in more effective mitral regurgitation (MR) reduction (residual MR ≤1+ at discharge for TMVR vs. M-TEER: 95.8% vs. 68.8%, p < 0.001), and superior symptomatic improvement (New York Heart Association class ≤II at 1 year: 77.8% vs. 64.3%, p = 0.015). CONCLUSION: In this PS-matched comparison between TMVR and M-TEER in patients with severe SMR, TMVR was associated with superior reduction of MR and superior symptomatic improvement. While post-procedural mortality tended to be higher after TMVR, no significant differences in mortality were found beyond 30 days.
Zeitschriftentitel:
Eur J Heart Fail
Jahr:
2023
Band / Volume:
25
Heft / Issue:
3
Seitenangaben Beitrag:
399-410
Volltext / DOI:
doi:10.1002/ejhf.2797
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/36883620
Print-ISSN:
1388-9842
TUM Einrichtung:
Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Lange)
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