Durability of Surgical Mitral Repair vs Transcatheter Edge-to-Edge Repair in Patients With Degenerative Mitral Regurgitation.

BACKGROUND

This study compared durability of mitral valve repair and changes in left ventricular function in patients with degenerative mitral regurgitation due to posterior leaflet prolapse undergoing transcatheter edge-to-edge mitral valve repair or surgical mitral valve repair.

METHODS

From January 1, 2014, to January 1, 2023, 1046 adults underwent successful mitral repair (mitral regurgitation [MR] <2+ and mean mitral gradient <10 mm Hg at predischarge echocardiography) with transcatheter (n = 97 [9%]) or surgical (n = 949 [91%]) mitral repair (leaflet resection + prosthetic annuloplasty) for posterior leaflet prolapse. Longitudinal analysis of postoperative echocardiography data was used to assess durability of repair and temporal ventricular remodeling. Groups were propensity matched (n = 56 matched pairs) on cardiac functional and morphologic characteristics.

RESULTS

Relative to the transcatheter group, surgical mitral repair patients had fewer comorbidities. Concomitant tricuspid repair was performed in 104 of 949 surgical (11%) and 11 of 97 transcatheter repairs (11%), and atrial fibrillation ablation in 112 of 949 surgical patients (12%). After adjusting for baseline differences in heart characteristics, 51 of 56 patients (91%) after transcatheter and 2 of 56 patients (4%) after surgical repair showed mild mitral regurgitation at predischarge echocardiography (P < .0001). In the matched groups, prevalence of moderate or severe mitral regurgitation at 1 and 3 years was 34% and 43% after transcatheter intervention and 1.6% and 3.4% after surgery (P < .0001), respectively. Freedom from reintervention at 3 years was 96% after transcatheter intervention and 100% after surgical repair.

CONCLUSIONS

Surgical repair provides superior midterm repair durability than transcatheter mitral repair in patients with degenerative mitral regurgitation caused by posterior leaflet prolapse. Further studies are warranted to better understand the clinical significance of this finding with regard to symptom burden and valve degeneration.