Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair: Mid-Term Outcomes From the CUTTING-EDGE International Registry |
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Affiliation: | 1. Brigham and Women’s Hospital, Boston, Massachusetts, USA;2. Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA;3. German Heart Center Munich, Munich, Germany;4. German Heart Center Berlin, Berlin, Germany;5. University Heart and Vascular Center Hamburg, Hamburg, Germany;6. LMU Klinikum Munich, Munich, Germany;7. Leipzig Heart Center, Leipzig, Germany;8. HerzZentrum Hirslanden, Zurich, Switzerland;9. University of California San Francisco Medical Center, San Francisco, California, USA;10. University of Michigan, Ann Arbor, Michigan, USA;11. Vanderbilt University Medical Center, Nashville, Tennessee, USA;12. Baylor, Scott & White The Heart Hospital, Plano, Texas, USA;13. CHU Rennes, Inserm, LTSI-UMR 1099, Université de Rennes 1, Rennes, France;14. Montreal Heart Institute, Montreal, Quebec, Canada;15. Lankenau Heart Institute, Philadelphia, Pennsylvania, USA;p. Emory University, Atlanta, Georgia, USA;q. St. Francis Hospital, Roslyn, New York, USA;r. Lenox Hill Hospital, New York, New York, USA;s. London Health Sciences Center, Western University, London, Ontario, Canada;t. Medical University of Vienna, Vienna, Austria;u. Hospices Civils de Lyon, Lyon, France;v. Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy;w. IRCCS Policlinico San Donato, Milan, Italy;x. Clinique Pasteur, Toulouse, France;y. Columbia University Irving Medical Center, New York, New York, USA;z. Abbott Northwestern Hospital, Minneapolis, Minnesota, USA;11. CHU Bordeaux, Bordeaux, France;22. San Raffaele University Hospital, Milan, Italy;33. Mount Sinai Health System, New York, New York, USA |
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Abstract: | ObjectivesThe aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER).BackgroundAlthough >100,000 mitral TEER procedures have been performed worldwide, longitudinal data on MV surgery after TEER are lacking.MethodsData from the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 9.0 months (interquartile range [IQR]: 1.2-25.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year.ResultsFrom July 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. The mean age was 73.8 ± 10.1 years, median Society of Thoracic Surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. The median interval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median Society of Thoracic Surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. The 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. On Kaplan-Meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery.ConclusionsIn this first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only <10% of patients underwent MV repair. These registry data provide valuable insights for further research to improve these outcomes. |
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Keywords: | mitral valve replacement mitral valve surgery transcatheter edge-to-edge repair IQR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" interquartile range LVEF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" left ventricular ejection fraction MR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" mitral regurgitation MV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" mitral valve O/E" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" observed-to-expected PROM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" Predicted Risk of Mortality SLDA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" single-leaflet device attachment STS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" Society of Thoracic Surgeons TEER" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" transcatheter edge-to-edge repair TR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" tricuspid regurgitation TV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0140" }," $$" :[{" #name" :" text" ," _" :" tricuspid valve |
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