Transcatheter or surgical repair for degenerative mitral regurgitation in elderly patients: A propensity-weighted analysis

The Journal of Thoracic and Cardiovascular Surgery
N BuzzattiO Alfieri

Abstract

To compare the outcomes of MitraClip and surgical mitral repair in low-intermediate risk elderly patients affected by degenerative mitral regurgitation (DMR). We retrospectively selected patients aged ≥75 years, with Society of Thoracic Surgeons Predicted Risk Of Mortality (STS-PROM) <8%, submitted to MitraClip (n = 100) or isolated surgical repair (n = 206) for DMR at 2 centers between January 2005 and May 2017. To adjust for baseline imbalances, we used a propensity score model for average treatment effect on survival. After weighting, MitraClip showed fewer postoperative complications (P < .05) but increased residual mitral regurgitation (MR) ≥2 (27.0% vs 2.8%, P < .001) compared with surgery. One-year survival was greater after MitraClip compared with surgery (97.6% vs 95.3%, hazard ratio [HR], 0.09; confidence interval [CI], 0.02-0.37, P = .001), whereas 5-year survival was lower (34.5% vs 82.2% respectively, HR, 4.12; CI, 2.31-7.34, P < .001). Greater STS-PROM (HR, 1.18; CI, 1.12-1.24, P < .001) and MR ≥3+ recurrence (HR, 2.18; CI, 1.07-4.48, P = .033) were associated with reduced survival. 5-year MR ≥3+ was more frequent after MitraClip compared with surgery: 36.9% versus 3.9%, odds ratio, 11.4; CI, 4.40-29.68, P < .001....Continue Reading

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Citations

Jun 5, 2019·Current Treatment Options in Cardiovascular Medicine·Katherine Lee ChuyDipti Gupta
Jul 20, 2019·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Giuseppe D'Ancona, Hüseyin Ince
Jan 7, 2020·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Hunbo ShimTsuyoshi Kaneko
Nov 20, 2020·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Atsushi SugiuraJan-Malte Sinning
Jan 12, 2021·Journal of Cardiac Surgery·Ashiq A KhaderThanos Athanasiou
Dec 17, 2019·The Journal of Thoracic and Cardiovascular Surgery·Joanna Chikwe, Alfredo Trento
Mar 31, 2021·Journal of Cardiac Surgery·Antonio M CalafioreMichele Di Mauro
Feb 26, 2019·The Journal of Thoracic and Cardiovascular Surgery·Abe DeAnda, Syed A Gilani
Apr 18, 2019·The Journal of Thoracic and Cardiovascular Surgery·Paul Kurlansky
Aug 29, 2021·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Alec VahanianUNKNOWN ESC/EACTS Scientific Document Group
Aug 29, 2021·European Heart Journal·Alec VahanianUNKNOWN ESC Scientific Document Group
Nov 19, 2021·Interactive Cardiovascular and Thoracic Surgery·Mathias Van HemelrijckCarlos-A Mestres
Nov 21, 2020·Journal of the American College of Cardiology·George D Dangas, David H Adams
Dec 26, 2021·Journal of Cardiac Surgery·Hideki TsubotaAkira Marui
Dec 22, 2021·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Alec VahanianWojtek Wojakowski

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