Abstract 18577: Survival Benefits of Transcatheter Mitral Valve Repair is Comparable to Surgery, but Superior to Conservative Treatment in High Risk Patients
Objective: Up to 50% of patients with symptomatic severe mitral valve regurgitation (MR) are denied for surgery due to high perioperative risk. Transcatheter repair using MitraClip might be a good alternative. We compared mortality outcome between MitraClip, surgery and conservative treatment in high risk patients.
Methods: Consecutive patients treated with the MitraClip system were included. Comparator surgical and conservative treated patients were identified retrospectively and consented to compare survival. Surgical risk was based on logistic EuroSCORE or the presence of relevant risk factors, judged by the heart team.
Results: Mean follow-up time was 3.8±0.2 years. 251 patients were included of whom 59 were treated conservatively, 139 treated with MitraClip and 53 underwent surgery. Logistic EuroSCORE was higher in MitraClip (23.9±16.1) than in surgical (14.2±8.9) and conservative (18.7±13.2, P<0.0001) treated patients. MitraClip patients (74.6±9.4) were older than those in the surgical (70.2±9.5) and conservative (71.7±9.6, P=0.009) groups. Majority of patients had functional MR. LVEF was better in surgery group (43.9±14.4%), with similar values for MitraClip (36.8±15.3%) and conservative treated subjects (34.5±16.5%, P=0.003). PHT (sPAP >31mmHg) was more prevalent in MitraClip than in conservative and surgery patients. Incidence of other risk factors did not differ. The mortality rates were 23,0%, 45,3%, and 67,8% for Mitraclip, high risk surgery and conservative treatment, respectively. However due to the retrospective character of the comparator groups, the Mitraclip group had a shorter follow-up time. After weighting for propensity score and controlling for age, COPD and PHT both MitraClip (HR=0.50 95%CI [0.28 - 0.88], p=0.02) and surgical group (HR=0.53 95%CI [0.32 - 0.89], p=0.02) showed better survival than the conservative group. MitraClip and surgical groups did not differ (HR=1.06 95%CI [0.60 - 1.88], p=0.84).
Conclusion: Despite higher logistic EuroSCORE, high risk patients with severe symptomatic MR treated with the MitraClip have similar mortality outcomes compared to those treated surgically, both showing survival benefit compared to conservative treatment.
- © 2013 by American Heart Association, Inc.