Mitral transcatheter edge to edge repair versus isolated mitral surgery for severe mitral regurgitation: A French nationwide study,European Heart Journal

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Mitral transcatheter edge to edge repair versus isolated mitral surgery for severe mitral regurgitation: A French nationwide study
European Heart Journal ( IF 39.3 ) Pub Date : 2024-01-17 , DOI: 10.1093/eurheartj/ehae046
Pierre Deharo _{1,

2} , Jean Francois Obadia ₃ , Patrice Guerin ₄ , Thomas Cuisset _{1,

2} , Jean Francois Avierinos ₁ , Gilbert Habib ₁ , Olivier Torras ₁ , Arnaud Bisson ₅ , Pascal Vigny ₆ , Christophe Saint Etienne ₅ , Carl Semaan ₅ , Mickael Guglieri ₅ , Nicolas Dumonteil ₇ , Frederic Collart _{2,

8} , Martine Gilard ₉ , Thomas Modine ₁₀ , Erwan Donal ₁₁ , Bernard Iung ₁₂ , Laurent Fauchier ₃

Affiliation

Département de Cardiologie, CHU Timone , Marseille , France
Aix Marseille Univ, Inserm, Inra, C2VN , Marseille , France
Hôpital Cardiovasculaire Louis Pradel, Chirurgie Cardio-Vasculaire et Transplantation Cardiaque, 28, Ave. Doyen Lépine , 69677 Bron CEDEX , France
Service de Cardiologie, Centre Hospitalier Universitaire de Nantes , Nantes , France
Service de Cardiologie, Centre Hospitalier Trousseau , Tours , France
Service d'information médicale, Unité d’épidémiologie hospitalière régionale, Université de Tours , France
Groupe CardioVasculaire Interventionnel, Clinique Pasteur , Toulouse , France
Département de Chirurgie Cardiaque, CHU Timone , Marseille , France
Department of Cardiology, CHRU Brest , 29200 Brest , France
Département de Cardiologie, CHU Bordeaux , Bordeaux , France
University of Rennes, CHU Rennes, Inserm, LTSI – UMR 1099 , F-35000 Rennes , France
AP-HP, Cardiology Department, Bichat Hospital, Université Paris Cité, INSERM 1148 , Paris , France

Background and Aims Mitral valve surgery and more recently mitral transcatheter edge-to-edge repair (TEER) are the two treatments of severe mitral regurgitation in eligible patients. Clinical comparison of both therapies remains limited by the number of patients analysed. The objective of this study was to analyse the outcomes of mitral TEER versus isolated mitral valve surgery at a nationwide level in France. Methods Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients treated for mitral regurgitation with isolated TEER or isolated mitral valve surgery between 2012 and 2022. Propensity score matching was used for the analysis of outcomes. Results A total of 57,030 patients were found in the database. After matching on baseline characteristics, 2,160 patients were analysed in each arm. At 3-year follow-up, TEER was associated with significantly lower incidence of cardiovascular death (HR 0.685, 95% CI 0.563-0.832; p < 0.001), pacemaker implantation and stroke. Non-cardiovascular death (HR 1.562, 95% CI 1.238-1.971; p = 0.0001), recurrent pulmonary edema and cardiac arrest were more frequent after TEER. No significant differences between the two groups were observed regarding all-cause death (HR 0.967, 95% CI 0.835-1.118; p = 0.65), endocarditis, major bleeding and atrial fibrillation and myocardial infarction. Conclusions Our results suggest that TEER for severe mitral regurgitation was associated with lower cardiovascular mortality than mitral surgery at long-term follow-up. Pacemaker implantation and stroke were less frequently observed after TEER.

更新日期：2024-01-17

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