Objectives

The aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER).

Background

Although >100,000 mitral TEER procedures have been performed worldwide, longitudinal data on MV surgery after TEER are lacking.

Methods

Data from the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 9.0 months (interquartile range [IQR]: 1.2-25.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year.

Results

From July 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. The mean age was 73.8 ± 10.1 years, median Society of Thoracic Surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. The median interval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median Society of Thoracic Surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. The 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. On Kaplan-Meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery.

Conclusions

In this first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only <10% of patients underwent MV repair. These registry data provide valuable insights for further research to improve these outcomes.

中文翻译：

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经导管边缘对边缘修复后的二尖瓣手术

目标

本研究的目的是确定经导管边缘对边缘修复 (TEER) 后二尖瓣 (MV) 手术的临床和超声心动图特征、失败机制和结果。

背景

尽管全世界已经进行了超过 100,000 次二尖瓣 TEER 手术，但缺乏 TEER 后 MV 手术的纵向数据。

方法

对来自多中心、国际 CUTTING-EDGE 注册中心的数据进行了回顾性分析。评估了临床和超声心动图结果。MV 手术后中位随访时间为 9.0 个月（四分位距 [IQR]：1.2-25.7 个月），30 天随访完成率为 96.1%，1 年随访完成率为 81.1%。

结果

从 2009 年 7 月到 2020 年 7 月，来自 34 个中心的 332 名患者在 TEER 后接受了 MV 手术。平均年龄为 73.8 ± 10.1 岁，胸外科医师协会在初始 TEER 时进行 MV 修复的中位风险为 4.0（IQR：2.3-7.3），原发性/混合性和继发性二尖瓣反流分别占 59.0% 和 38.5%。从 TEER 到手术的中位间隔为 3.5 个月（IQR：0.5-11.9 个月），胸外科医师协会的 MV 置换的总体中位风险为 4.8%（IQR：2.8%-8.4%）。手术的主要适应症是复发性二尖瓣关闭不全 (33.5%)，分别有 92.5% 和 42.2% 的患者进行了 MV 置换术和伴随的三尖瓣手术。30 天和 1 年死亡率分别为 16.6% 和 31.3%。在 Kaplan-Meier 分析中，死亡率的精算估计值为 24。

结论

在 CUTTING-EDGE 注册的第一份报告中，TEER 后 MV 手术的死亡率和发病率风险不容忽视，只有 <10% 的患者接受了 MV 修复。这些注册数据为进一步研究以改善这些结果提供了宝贵的见解。