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Late-Breaking Science: TEER versus mitral surgery – how do they compare?

26 Aug 2023

Yesterday’s insightful Late-Breaking Science session on valvular heart disease ended with a presentation from Doctor Pierre Deharo (Hospital La Timone of Marseille - Marseille, France) on a nationwide analysis comparing outcomes following mitral transcatheter edge­-to-­edge repair (TEER) or mitral valve surgery for patients with severe mitral regurgitation (MR).

The researchers collected information for all consecutive patients treated for MR with isolated TEER or isolated mitral valve surgery between 2012 and 2022 from the French administrative hospital-discharge database and used propensity score matching to analyse outcomes. In total, 598,036 patients suffering from severe MR were identified in the database, including 57,140 patients who underwent either isolated mitral valve surgery or isolated TEER. In the unmatched population, patients treated with TEER were older, with higher rates of CV risk factors, vascular disease, chronic kidney disease and percutaneous coronary intervention history. Of note, patients with mitral surgery were more often included in the early years of the analysis, while those with TEER were included more latterly. After propensity score matching, there were 2,160 patients in each group and mean follow-up was 1.0 (SD 1.2) year.

Overall, the incidence of all-cause death was similar for TEER compared with surgery (hazard ratio [HR] 0.967; 95% CI 0.835 to 1.118; p=0.65).

However, CV death was significantly lower with TEER (7.96%) than surgery (11.44%; HR 0.685; 95% CI 0.563 to 0.832; p=0.0001).

A significant interaction was observed with EuroSCORE II, such that EuroSCORE II 4 was associated with significantly lower incidence of all-cause death (HR 0.48; 95% CI 0.361 to 0.663; p value for interaction=0.0001) and CV death (HR 0.487; 95% CI 0.322 to 0.736; p value for interaction=0.0006) after TEER versus surgery in comparison with those with EuroSCORE II <4. Similarly, in patients older than 75 years, TEER was associated with lower all-cause death compared with surgery (HR 0.627; 95% CI 0.453 to 0.870; p value for interaction=0.005) and CV death (HR 0.611; 95% CI 0.391 to 0.955; p value for interaction=0.03) compared with those younger than 75 years. Moreover, when restricting analysis to surgical repair versus TEER and mitral surgery versus TEER in functional MR only, similar results were observed.

Across the whole matched population, TEER was associated with significantly lower incidence of recurrent pulmonary oedema (HR 0.701; 95% CI 0.584 to 0.842; p=0.0001), pacemaker implantation (HR 0.631; 95% CI 0.541 to 0.736; p=0.0001), stroke (HR 0.637; 95% CI 0.466 to 0.869; p=0.004), endocarditis (HR 0.592; 95% CI 0.429 to 0.817; p=0.001), major bleeding (HR 0.592; 95% CI 0.429 to 0.817; p=0.0001) and atrial fibrillation (HR 0.590; 95% CI 0.517 to 0.674; p=0.0001). The incidence of cardiac arrest (HR 0.946; 95% CI 0.749 to 1.193; p=0.64) and myocardial infarction (HR 0.676; 95% CI 0.441 to 1.037; p=0.07) did not differ significantly between the two groups.

Dr. Deharo concludes, “We observed that TEER for severe MR was associated with lower CV mortality than mitral surgery at long-term follow-up and were able to identify patient groups who derived the greatest benefit from TEER. These real-life long-term follow-up data are reassuring for TEER outcomes. Therefore, the Heart Team could consider TEER in patients with severe MR and particularly in those with EuroSCORE II 4 and patients older than 75 years.”