Mitral transcatheter edge-to-edge repair vs. isolated mitral surgery for severe mitral regurgitation: a French nationwide study
Selected in European Heart Journal by S. Brugaletta
The present analysis represents the largest comparison between surgical vs. percutaneous repair of mitral valve.
References
Authors
Pierre Deharo, Jean Francois Obadia, Patrice Guerin, Thomas Cuisset, Jean Francois Avierinos, Gilbert Habib, Olivier Torras, Arnaud Bisson, Pascal Vigny, Christophe Saint Etienne, Carl Semaan, Mickael Guglieri, Nicolas Dumonteil, Frederic Collart, Martine Gilard, Thomas Modine, Erwan Donal, Bernard Iung, Laurent Fauchier
Reference
European Heart Journal, ehae046, https://doi.org/10.1093/eurheartj/ehae046
Published
19 January 2024
Link
Read the abstractReviewer
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Why this study – the rationale/objective?
Mitral valve surgery and, more recently, mitral transcatheter edge-to-edge repair (TEER) are the two treatments of severe mitral regurgitation in eligible patients.
Clinical comparison of both therapies remains limited by the number of patients analysed.
The objective of this study was to analyse the outcomes of mitral TEER vs. isolated mitral valve surgery at a nationwide level in France.
How was it executed – the methodology?
Based on the French administrative hospital discharge database, the study collected information for all consecutive patients treated for mitral regurgitation with isolated TEER or isolated mitral valve surgery between 2012 and 2022. Propensity score matching was used for the analysis of outcomes.
What is the main result?
A total of 57,030 patients were found in the database. After matching on baseline characteristics, 2,160 patients were analysed in each arm.
At 3-year follow-up, TEER was associated with significantly lower incidence of cardiovascular death (hazard ratio 0.685, 95 % confidence interval 0.563–0.832; P = .0001), pacemaker implantation, and stroke.
Non-cardiovascular death (hazard ratio 1.562, 95 % confidence interval 1.238–1.971; P = .0002), recurrent pulmonary oedema, and cardiac arrest were more frequent after TEER.
No significant differences between the two groups were observed regarding all-cause death (hazard ratio 0.967, 95 % confidence interval 0.835–1.118; P = .65), endocarditis, major bleeding, atrial fibrillation, and myocardial infarction.
Critical reading and the relevance for clinical practice
The present analysis represents the largest comparison between surgical vs. percutaneous repair of mitral valve. The authors should be congratulated for collecting and analyzing data from such large population.
It is clear that TEER has an outcome comparable to surgical repair in terms of all-cause death, with some advantages when we consider cardiovascular death.
Some points should be considered in data interpreting. When outcomes are adjudicated based on ICD-10, it is always difficult to believe that 100 % of the events different than all-cause death are correctly adjudicated. However, to adjudicate one-by-one more than 700 events in a different way would have been impossible.
The authors used propensity score matching to compare the two techniques: this does not mean that outcomes following any of the two techniques are comparable in a general population, but only in a population similar to that selected by the propensity score matching.
The next important step should be to identify the population who may benefit the most from one or the other technique in order to customize the treatment according to the type of patients and of the mitral anatomy.
For a more in-depth look at the subject, watch or re-watch the interview with Pierre Deharo conducted by Alessandro Sticchi at ESC 2023!
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