Background: The impact of mitral valve (MV) surgery type after failed mitral transcatheter edge-to-edge repair (M-TEER) has not been well studied. Objectives: The aim of this study was to compare the outcomes of MV repair vs replacement after failed M-TEER. Methods: From 2009 to 2020, a total of 332 patients across 34 centers from the CUTTING-EDGE registry underwent MV surgery after M-TEER. Outcomes were compared between MV repair and replacement. Primary outcomes included 30-day mortality and 1-year survival after MV surgery. Results: Among enrolled patients (mean age 73.8 ± 10.1 years, median Society of Thoracic Surgeons Predicted Risk of Mortality 3.9% [Q1-Q3: 2.2%-6.8%]), 25 (7.5%) underwent repair and 307 (92.5%) underwent replacement. The replacement group had a significantly higher rate of comorbidities, including atrial fibrillation, prior cardiac surgery, more secondary mitral regurgitation, and more devices implanted at index M-TEER (P < 0.05 for all). Replacement patients showed a trend toward higher 30-day mortality (17.7% [52 of 294] vs 4.0% [1 of 25]; P = 0.094). The observed-to-expected ratio of 30-day mortality was 3.6 (95% CI: 1.9-5.3) overall, 3.8 (95% CI: 2.1-5.5) in the replacement group, and 1.7 (95% CI: 0.7-3.3) in the repair group. Replacement patients had higher 1-year mortality (33.3% [65 of 195] vs 10.5% [2 of 19]; P = 0.041). Significantly lower survival rates were observed after replacement at 2 years (P = 0.033) and persisted in the risk-adjusted Cox regression analysis (HR for replacement: 4.24; 95% CI: 1.04-17.31; P = 0.044). Conclusions: MV surgery after failed M-TEER is a high-risk procedure associated with higher than expected 30-day mortality, with higher mortality associated with MV replacement. Compared with repair, replacement is associated with higher 1-year mortality and a lower 2-year survival.
Surgical Mitral Valve Repair vs Replacement After Failed Mitral Transcatheter Edge-to-Edge Repair: The CUTTING-EDGE Registry / Marin-Cuartas, M.; Kang, J.; Noack, T.; De La Cuesta, M.; Krane, M.; Falk, V.; Conradi, L.; Hagl, C.; Taramasso, M.; Nguyen, T. C.; Lim, D. S.; Ailawadi, G.; Mack, M. J.; Smith, R. L.; Asgar, A. W.; Grubb, K. J.; Pirelli, L.; Denti, P.; Modine, T.; Reardon, M. J.; Nazif, T. M.; Bapat, V. N.; Kaneko, T.; Kiefer, P.; Borger, M. A.; Tang, G. H. L.; Zaid, S.; Vitanova, K.; Lange, R.; Akansel, S.; Kempfert, J.; Bhadra, O. D.; Ascione, G.; Saha, S.; Bagaev, E.; Fahr, F.; Tagliari, A. P.; Maisano, F.; Pizano, A.; Donatelle, M.; Romano, M. A.; Squiers, J. J.; Dimaio, J. M.; Goel, K.; Shah, A. S.; Szerlip, M.; Leurent, G.; Anselmi, A.; Corbineau, H.; Shah, P. B.; Hirji, S.; Bouchard, D.; Pellerin, M.; Demers, P.; Ben Ali, W.; Ruaengsri, C.; Ramlawi, B.; Wang, L.; Petrossian, G. A.; Robinson, N. B.; Leroux, L.; Kliger, C. A.; Flagiello, M.; Obadia, J. -F.; Algadheeb, M.; Chu, M. W. A.; Lavi, S.; Werner, P.; Andreas, M.; Ghattas, A.; Dumonteil, N.; Tchetche, D.; Bartorelli, A. L.; Garatti, A.; Gennari, M.; Wyler Von Ballmoos, M.; Goel, S. S.; Kleiman, N. S.; Atkins, M. D.; Kaple, R. K.; Van Belle, E.; Vincent, F.; Denimal, T.; Massi, F.; Triggiani, M.; D'Onofrio, A.; Tessari, C.; Brinkmann, C.; Schofer, J.; Capestro, F.; Di Eusanio, M.; Pinon, M. A.; Estevez-Loureiro, R.; Geirsson, A.; George, I.; Hahn, R. T.. - In: JACC: CARDIOVASCULAR INTERVENTIONS. - ISSN 1936-8798. - 18:7(2025), pp. 912-923. [10.1016/j.jcin.2025.02.008]
Surgical Mitral Valve Repair vs Replacement After Failed Mitral Transcatheter Edge-to-Edge Repair: The CUTTING-EDGE Registry
Ascione G.;Maisano F.;Anselmi A.;D'Onofrio A.;
2025-01-01
Abstract
Background: The impact of mitral valve (MV) surgery type after failed mitral transcatheter edge-to-edge repair (M-TEER) has not been well studied. Objectives: The aim of this study was to compare the outcomes of MV repair vs replacement after failed M-TEER. Methods: From 2009 to 2020, a total of 332 patients across 34 centers from the CUTTING-EDGE registry underwent MV surgery after M-TEER. Outcomes were compared between MV repair and replacement. Primary outcomes included 30-day mortality and 1-year survival after MV surgery. Results: Among enrolled patients (mean age 73.8 ± 10.1 years, median Society of Thoracic Surgeons Predicted Risk of Mortality 3.9% [Q1-Q3: 2.2%-6.8%]), 25 (7.5%) underwent repair and 307 (92.5%) underwent replacement. The replacement group had a significantly higher rate of comorbidities, including atrial fibrillation, prior cardiac surgery, more secondary mitral regurgitation, and more devices implanted at index M-TEER (P < 0.05 for all). Replacement patients showed a trend toward higher 30-day mortality (17.7% [52 of 294] vs 4.0% [1 of 25]; P = 0.094). The observed-to-expected ratio of 30-day mortality was 3.6 (95% CI: 1.9-5.3) overall, 3.8 (95% CI: 2.1-5.5) in the replacement group, and 1.7 (95% CI: 0.7-3.3) in the repair group. Replacement patients had higher 1-year mortality (33.3% [65 of 195] vs 10.5% [2 of 19]; P = 0.041). Significantly lower survival rates were observed after replacement at 2 years (P = 0.033) and persisted in the risk-adjusted Cox regression analysis (HR for replacement: 4.24; 95% CI: 1.04-17.31; P = 0.044). Conclusions: MV surgery after failed M-TEER is a high-risk procedure associated with higher than expected 30-day mortality, with higher mortality associated with MV replacement. Compared with repair, replacement is associated with higher 1-year mortality and a lower 2-year survival.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
