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

Sebastian Ludwig; Daniel Kalbacher; Walid Ben Ali; Jessica Weimann; Matti Adam; Alison Duncan; John G Webb; Stephan Windecker; Mathias Orban; Cristina Giannini; Augustin Coisne; Nicole Karam; Andrea Scotti; Lars Sondergaard; Marianna Adamo; David W M Muller; Christian Butter; Paolo Denti; Bruno Melica; Damiano Regazzoli; Andrea Garatti; Tobias Schmidt; Martin Andreas; Gry Dahle; Maurizio Taramasso; Georg Nickenig; Nicolas Dumonteil; Thomas Walther; Michele Flagiello; Joerg Kempfert; Neil Fam; Hendrik Ruge; Tanja K Rudolph; Moritz C Wyler von Ballmoos; Marco Metra; Simon Redwood; Juan F Granada; Gilbert H L Tang; Azeem Latib; Philipp Lurz; Ralph Stephan von Bardeleben; Thomas Modine; Jörg Hausleiter; Lenard Conradi; on behalf of the CHOICE-MI and the EuroSMR Investigators (see online Appendix S1)

doi:10.1002/ejhf.2797

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

Sebastian Ludwig^*, Daniel Kalbacher, Walid Ben Ali, Jessica Weimann, Matti Adam, Alison Duncan, John G Webb, Stephan Windecker, Mathias Orban, Cristina Giannini, Augustin Coisne, Nicole Karam, Andrea Scotti, Lars Sondergaard, Marianna Adamo, David W M Muller, Christian Butter, Paolo Denti, Bruno Melica, Damiano RegazzoliAndrea Garatti, Tobias Schmidt, Martin Andreas, Gry Dahle, Maurizio Taramasso, Georg Nickenig, Nicolas Dumonteil, Thomas Walther, Michele Flagiello, Joerg Kempfert, Neil Fam, Hendrik Ruge, Tanja K Rudolph, Moritz C Wyler von Ballmoos, Marco Metra, Simon Redwood, Juan F Granada, Gilbert H L Tang, Azeem Latib, Philipp Lurz, Ralph Stephan von Bardeleben, Thomas Modine, Jörg Hausleiter, Lenard Conradi, on behalf of the CHOICE-MI and the EuroSMR Investigators (see online Appendix S1)

^*Corresponding author for this work

Department of Cardiology

29 Citations (Scopus)

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.

Original language	English
Journal	European Journal of Heart Failure
Volume	25
Issue number	3
Pages (from-to)	399-410
Number of pages	12
ISSN	1388-9842
DOIs	https://doi.org/10.1002/ejhf.2797
Publication status	Published - Mar 2023

Keywords

Cardiac Catheterization/methods
Female
Heart Failure
Heart Valve Prosthesis Implantation/methods
Humans
Male
Mitral Valve Insufficiency/surgery
Mitral Valve/diagnostic imaging
Propensity Score
Treatment Outcome
Functional mitral regurgitation
Transcatheter edge-to-edge repair
Transcatheter mitral valve replacement
Secondary mitral regurgitation

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10.1002/ejhf.2797

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Ludwig, S., Kalbacher, D., Ali, W. B., Weimann, J., Adam, M., Duncan, A., Webb, J. G., Windecker, S., Orban, M., Giannini, C., Coisne, A., Karam, N., Scotti, A., Sondergaard, L., Adamo, M., Muller, D. W. M., Butter, C., Denti, P., Melica, B., ... on behalf of the CHOICE-MI and the EuroSMR Investigators (see online Appendix S1) (2023). Transcatheter mitral valve replacement or repair for secondary mitral regurgitation: a propensity score-matched analysis. European Journal of Heart Failure, 25(3), 399-410. https://doi.org/10.1002/ejhf.2797

Ludwig, S, Kalbacher, D, Ali, WB, Weimann, J, Adam, M, Duncan, A, Webb, JG, Windecker, S, Orban, M, Giannini, C, Coisne, A, Karam, N, Scotti, A, Sondergaard, L, Adamo, M, Muller, DWM, Butter, C, Denti, P, Melica, B, Regazzoli, D, Garatti, A, Schmidt, T, Andreas, M, Dahle, G, Taramasso, M, Nickenig, G, Dumonteil, N, Walther, T, Flagiello, M, Kempfert, J, Fam, N, Ruge, H, Rudolph, TK, Wyler von Ballmoos, MC, Metra, M, Redwood, S, Granada, JF, Tang, GHL, Latib, A, Lurz, P, von Bardeleben, RS, Modine, T, Hausleiter, J, Conradi, L & on behalf of the CHOICE-MI and the EuroSMR Investigators (see online Appendix S1) 2023, 'Transcatheter mitral valve replacement or repair for secondary mitral regurgitation: a propensity score-matched analysis', European Journal of Heart Failure, vol. 25, no. 3, pp. 399-410. https://doi.org/10.1002/ejhf.2797

@article{5c5b6789ad8344a4a7787a29c80d01e4,

title = "Transcatheter mitral valve replacement or repair for secondary mitral regurgitation: a propensity score-matched analysis",

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.",

keywords = "Cardiac Catheterization/methods, Female, Heart Failure, Heart Valve Prosthesis Implantation/methods, Humans, Male, Mitral Valve Insufficiency/surgery, Mitral Valve/diagnostic imaging, Propensity Score, Treatment Outcome, Functional mitral regurgitation, Transcatheter edge-to-edge repair, Transcatheter mitral valve replacement, Secondary mitral regurgitation",

author = "Sebastian Ludwig and Daniel Kalbacher and Ali, \{Walid Ben\} and Jessica Weimann and Matti Adam and Alison Duncan and Webb, \{John G\} and Stephan Windecker and Mathias Orban and Cristina Giannini and Augustin Coisne and Nicole Karam and Andrea Scotti and Lars Sondergaard and Marianna Adamo and Muller, \{David W M\} and Christian Butter and Paolo Denti and Bruno Melica and Damiano Regazzoli and Andrea Garatti and Tobias Schmidt and Martin Andreas and Gry Dahle and Maurizio Taramasso and Georg Nickenig and Nicolas Dumonteil and Thomas Walther and Michele Flagiello and Joerg Kempfert and Neil Fam and Hendrik Ruge and Rudolph, \{Tanja K\} and \{Wyler von Ballmoos\}, \{Moritz C\} and Marco Metra and Simon Redwood and Granada, \{Juan F\} and Tang, \{Gilbert H L\} and Azeem Latib and Philipp Lurz and \{von Bardeleben\}, \{Ralph Stephan\} and Thomas Modine and J{\"o}rg Hausleiter and Lenard Conradi and \{ on behalf of the CHOICE-MI and the EuroSMR Investigators (see online Appendix S1)\}",

note = "{\textcopyright} 2023 The Authors. European Journal of Heart Failure published by John Wiley \& Sons Ltd on behalf of European Society of Cardiology.",

year = "2023",

month = mar,

doi = "10.1002/ejhf.2797",

language = "English",

volume = "25",

pages = "399--410",

journal = "European Journal of Heart Failure",

issn = "1388-9842",

publisher = "Oxford University Press",

number = "3",

}

TY - JOUR

T1 - Transcatheter mitral valve replacement or repair for secondary mitral regurgitation

T2 - a propensity score-matched analysis

AU - Ludwig, Sebastian

AU - Kalbacher, Daniel

AU - Ali, Walid Ben

AU - Weimann, Jessica

AU - Adam, Matti

AU - Duncan, Alison

AU - Webb, John G

AU - Windecker, Stephan

AU - Orban, Mathias

AU - Giannini, Cristina

AU - Coisne, Augustin

AU - Karam, Nicole

AU - Scotti, Andrea

AU - Sondergaard, Lars

AU - Adamo, Marianna

AU - Muller, David W M

AU - Butter, Christian

AU - Denti, Paolo

AU - Melica, Bruno

AU - Regazzoli, Damiano

AU - Garatti, Andrea

AU - Schmidt, Tobias

AU - Andreas, Martin

AU - Dahle, Gry

AU - Taramasso, Maurizio

AU - Nickenig, Georg

AU - Dumonteil, Nicolas

AU - Walther, Thomas

AU - Flagiello, Michele

AU - Kempfert, Joerg

AU - Fam, Neil

AU - Ruge, Hendrik

AU - Rudolph, Tanja K

AU - Wyler von Ballmoos, Moritz C

AU - Metra, Marco

AU - Redwood, Simon

AU - Granada, Juan F

AU - Tang, Gilbert H L

AU - Latib, Azeem

AU - Lurz, Philipp

AU - von Bardeleben, Ralph Stephan

AU - Modine, Thomas

AU - Hausleiter, Jörg

AU - Conradi, Lenard

AU - on behalf of the CHOICE-MI and the EuroSMR Investigators (see online Appendix S1)

PY - 2023/3

Y1 - 2023/3

N2 - 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.

AB - 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.

KW - Cardiac Catheterization/methods

KW - Female

KW - Heart Failure

KW - Heart Valve Prosthesis Implantation/methods

KW - Humans

KW - Male

KW - Mitral Valve Insufficiency/surgery

KW - Mitral Valve/diagnostic imaging

KW - Propensity Score

KW - Treatment Outcome

KW - Functional mitral regurgitation

KW - Transcatheter edge-to-edge repair

KW - Transcatheter mitral valve replacement

KW - Secondary mitral regurgitation

UR - https://www.scopus.com/pages/publications/85150515553

U2 - 10.1002/ejhf.2797

DO - 10.1002/ejhf.2797

M3 - Journal article

C2 - 36883620

SN - 1388-9842

VL - 25

SP - 399

EP - 410

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

IS - 3

ER -

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

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