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Tytuł:
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Mitral Surgery After Transcatheter Edge-to-Edge Repair: Society of Thoracic Surgeons Database Analysis.
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Autorzy:
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Chikwe J; Department of Cardiac Surgery, Cedars-Sinai, Los Angeles, California, USA. Electronic address: .
O'Gara P; Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Fremes S; Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada.
Sundt TM 3rd; Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
Habib RH; The Society of Thoracic Surgeons Research Center, Chicago, Illinois, USA.
Gammie J; Division of Cardiac Surgery, University of Maryland, Baltimore, Maryland, USA.
Gaudino M; Division of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
Badhwar V; Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Gillinov M; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Acker M; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Rowe G; Department of Cardiac Surgery, Cedars-Sinai, Los Angeles, California, USA.
Gill G; Department of Cardiac Surgery, Cedars-Sinai, Los Angeles, California, USA.
Goldstone AB; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Schwann T; Division of Cardiac Surgery, Baystate Health, Springfield, Massachusetts, USA.
Gelijns A; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Trento A; Department of Cardiac Surgery, Cedars-Sinai, Los Angeles, California, USA.
Mack M; Baylor Health Care System, Plano, Texas USA.
Adams DH; Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Źródło:
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Journal of the American College of Cardiology [J Am Coll Cardiol] 2021 Jul 06; Vol. 78 (1), pp. 1-9. Date of Electronic Publication: 2021 May 01.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Original Publication: [New York, N.Y.] : Elsevier Biomedical, [c1983-
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MeSH Terms:
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Cardiac Catheterization*/adverse effects
Cardiac Catheterization*/methods
Heart Valve Prosthesis Implantation*/adverse effects
Heart Valve Prosthesis Implantation*/methods
Mitral Valve*/diagnostic imaging
Mitral Valve*/pathology
Mitral Valve*/surgery
Mitral Valve Insufficiency*/diagnosis
Mitral Valve Insufficiency*/etiology
Mitral Valve Insufficiency*/mortality
Mitral Valve Insufficiency*/surgery
Postoperative Complications*/diagnosis
Postoperative Complications*/surgery
Reoperation*/adverse effects
Reoperation*/methods
Reoperation*/statistics & numerical data
Mitral Valve Annuloplasty/*adverse effects
Age Factors ; Aged ; Female ; Heart Valve Diseases/pathology ; Heart Valve Diseases/surgery ; Hospital Mortality ; Humans ; Male ; Mitral Valve Annuloplasty/methods ; Prognosis ; Recurrence ; Risk Factors ; United States
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Contributed Indexing:
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Keywords: mitral regurgitation; mitral repair; mitral valve replacement; transcatheter edge-to-edge mitral repair
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Entry Date(s):
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Date Created: 20210504 Date Completed: 20210810 Latest Revision: 20220113
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Update Code:
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20240104
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DOI:
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10.1016/j.jacc.2021.04.062
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PMID:
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33945832
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Background: Transcatheter edge-to-edge (TEER) mitral repair may be complicated by residual or recurrent mitral regurgitation. An increasing need for surgical reintervention has been reported, but operative outcomes are ill defined.
Objectives: This study evaluated national outcomes of mitral surgery after TEER.
Methods: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was used to identify 524 adults who underwent mitral surgery after TEER between July 2014 and June 2020. Emergencies (5.0%; n = 26), previous mitral surgery (5.3%; n = 28), or open implantation of transcatheter prostheses (1.5%; n = 8) were excluded. The primary outcome was 30-day or in-hospital mortality.
Results: In the study cohort of 463 patients, the median age was 76 years (interquartile range [IQR]: 67 to 81 years), median left ventricular ejection fraction was 57% (IQR: 48% to 62%), and 177 (38.2%) patients had degenerative disease. Major concomitant cardiac surgery was performed in 137 (29.4%) patients: in patients undergoing isolated mitral surgery, the median STS-predicted mortality was 6.5% (IQR: 3.9% to 10.5%), the observed mortality was 10.2% (n = 23 of 225), and the ratio of observed to expected mortality was 1.2 (95% confidence interval [CI]: 0.8 to 1.9). Predictors of mortality included urgent surgery (odds ratio [OR]: 2.4; 95% CI: 1.3 to 4.6), nondegenerative/unknown etiology (OR: 2.2; 95% CI: 1.1 to 4.5), creatinine of >2.0 mg/dl (OR: 3.8; 95% CI: 1.9 to 7.9) and age of >80 years (OR: 2.1; 95% CI: 1.1 to 4.4). In a volume outcomes analysis in an expanded cohort of 591 patients at 227 hospitals, operative mortality was 2.6% (n = 2 of 76) in 4 centers that performed >10 cases versus 12.4% (n = 64 of 515) in centers performing fewer (p = 0.01). The surgical repair rate after failed TEER was 4.8% (n = 22) and was 6.8% (n = 12) in degenerative disease.
Conclusions: This study indicates that mitral repair is infrequently achieved after failed TEER, which may have implications for treatment choice in lower-risk and younger patients with degenerative disease. These findings should inform patient consent for TEER, clinical trial design, and clinical performance measures.
Competing Interests: Funding Support and Author Disclosures Dr. O’Gara has served on the executive committees of the APOLLO Transcatheter Mitral Valve Replacement Trial for Medtronic and the EARLY TAVR trial for Edwards Lifesciences, outside the submitted work. Dr. Gammie is a consultant for Edwards Lifesciences; the founder of Protaryx Medical, and the founder of HARPOON medical. Dr. Badhwar discloses institutional research support for clinical trials and has served as a consultant (nonremunerative) for Abbott. Dr. Gillinov is a consultant to AtriCure, Medtronic, Abbott, CryoLife, Edwards Lifesicences, and ClearFlow; the Cleveland Clinic has rights to royalties from AtriCure. Dr. Trento has received research support from Edwards Lifesciences. Dr. Mack discloses nonfinancial support from Edwards Lifesciences, Medtronic, and Abbott. Dr. Adams discloses royalties/research support from Edwards Lifesciences and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(Copyright © 2021. Published by Elsevier Inc.)
Comment in: J Am Coll Cardiol. 2021 Jul 6;78(1):10-13. (PMID: 34059390)
Comment in: Nat Rev Cardiol. 2021 Aug;18(8):545-546. (PMID: 34155374)
Comment in: J Am Coll Cardiol. 2021 Dec 7;78(23):e293. (PMID: 34857101)
Comment in: J Am Coll Cardiol. 2021 Dec 7;78(23):e295. (PMID: 34857102)
