Article Impact Level: HIGH Data Quality: STRONG Summary of JAMA, 329(20), 1778. https://doi.org/10.1001/jama.2023.7089 Dr. Raj R. Makkar et al.
Points
- This research study examined the outcomes of transcatheter mitral valve repair in 19,088 patients with isolated degenerative mitral regurgitation (MR).
- The study found that 88.9% of patients achieved MR success, defined as moderate or less residual MR without severe stenosis, after transcatheter mitral valve repair.
- Patients with MR success had significantly lower 1-year mortality (14.0%) than those with unsuccessful procedures (26.7%).
- Among patients with MR success, the lowest 1-year mortality (11.4%) was observed in those with mild or less residual MR and meant mitral gradients of 5 mm Hg or less.
- These findings suggest that transcatheter mitral valve repair is a viable treatment option for patients with high surgical risk and isolated degenerative MR, potentially improving long-term outcomes and reducing mortality rates.
Summary
This research paper investigates the outcomes of transcatheter mitral valve repair for isolated degenerative mitral regurgitation (MR) in a real-world setting, using data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry. The study analyzed 19,088 consecutive patients with moderate to severe or severe degenerative MR who underwent nonemergent transcatheter mitral valve repair with the MitraClip device between 2014 and 2022. The median age of the patients was 82 years, with 48% being women. The median Society of Thoracic Surgeons predicted mortality risk with surgical mitral valve repair was 4.6%.
The primary outcome measure, MR success, was defined as moderate or less residual MR and a mean mitral gradient of less than 10 mm Hg. The study found that MR success was achieved in 88.9% of patients who underwent transcatheter mitral valve repair. At 30 days post-procedure, the incidence of death was 2.7%, stroke was 1.2%, and mitral valve reintervention was 0.97%. Comparing patients with MR success to those with an unsuccessful procedure, MR success was associated with significantly lower 1-year mortality (14.0% vs. 26.7%). Additionally, patients with MR success had lower heart failure readmission rates at one year (8.4% vs. 16.9%). The study also identified a subgroup of patients with the lowest mortality rates (11.4%) among those with MR success. These patients had mild or less residual MR, which meant mitral gradients of 5 mm Hg or less.
Based on these findings, the study concludes that transcatheter mitral valve repair is a safe and effective treatment option for patients with degenerative MR. The procedure’s high success rate, with 88.9% of patients achieving MR success, indicates its feasibility in a real-world setting. Notably, patients with mild or less residual MR and low mitral gradients had the lowest mortality rates, highlighting the importance of achieving optimal outcomes in these parameters. These results provide valuable insights into the clinical outcomes of transcatheter mitral valve repair and support its use as a reasonable treatment option for patients with high surgical risk and isolated degenerative MR. Continued research and long-term follow-up are essential to further evaluate the durability and effectiveness of this procedure in real-world clinical practice.
Link to the article: https://jamanetwork.com/journals/jama/article-abstract/2805140
References Makkar, R. R., Chikwe, J., Chakravarty, T., Chen, Q., O’Gara, P. T., Gillinov, M., Mack, M. J., Vekstein, A., Patel, D., Stebbins, A. L., Gelijns, A. C., Makar, M., Bhatt, D. L., Kapadia, S., Vemulapalli, S., & Leon, M. B. (2023). Transcatheter mitral valve repair for degenerative mitral regurgitation. JAMA, 329(20), 1778. https://doi.org/10.1001/jama.2023.7089
