Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score–Matched Comparison-Reference-Cited by-同舟云学术

Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score–Matched Comparison

Published:2023-06 Issue:6 Volume:16 Page:
ISSN:1941-7640
Container-title:Circulation: Cardiovascular Interventions
language:en
Short-container-title:Circ: Cardiovascular Interventions

Author:

Ludwig Sebastian¹²³^ORCID,Conradi Lenard⁴^ORCID,Cohen David J.³⁵^ORCID,Coisne Augustin³⁶^ORCID,Scotti Andrea³⁷^ORCID,Abraham William T.⁸^ORCID,Ben Ali Walid⁹,Zhou Zhipeng³,Li Yanru³^ORCID,Kar Saibal¹⁰¹¹^ORCID,Duncan Alison¹²^ORCID,Lim D. Scott¹³,Adamo Marianna¹⁴¹⁵^ORCID,Redfors Björn³¹⁶¹⁷¹⁸^ORCID,Muller David W.M.¹⁹²⁰^ORCID,Webb John G.²¹,Petronio Anna S.²²,Ruge Hendrik²³²⁴^ORCID,Nickenig Georg²⁵,Sondergaard Lars²⁶,Adam Matti¹⁵^ORCID,Regazzoli Damiano²⁷,Garatti Andrea²⁸^ORCID,Schmidt Tobias²⁹,Andreas Martin³⁰^ORCID,Dahle Gry³¹^ORCID,Walther Thomas³²^ORCID,Kempfert Joerg³³,Tang Gilbert H.L.³⁴^ORCID,Redwood Simon³⁵^ORCID,Taramasso Maurizio³⁶,Praz Fabien³⁷^ORCID,Fam Neil³⁸,Dumonteil Nicolas³⁹,Obadia Jean-François⁴⁰^ORCID,von Bardeleben Ralph Stephan⁴¹^ORCID,Rudolph Tanja K.⁴²^ORCID,Reardon Michael J.⁴³^ORCID,Metra Marco¹⁴^ORCID,Denti Paolo⁴⁴^ORCID,Mack Michael J.⁴⁵^ORCID,Hausleiter Jörg⁴⁶^ORCID,Asch Federico M.⁴⁷^ORCID,Latib Azeem⁷^ORCID,Lindenfeld JoAnn⁴⁸,Modine Thomas⁴⁹^ORCID,Stone Gregg W.⁵⁰^ORCID,Granada Juan F.³^ORCID,

Affiliation:

1. Departments of Cardiology (S.L.), University Heart and Vascular Center Hamburg, Germany.

2. German Center for Cardiovascular Research, Partner site Hamburg/Kiel/Lübeck, Germany (S.L.).

3. Cardiovascular Research Foundation, New York City, NY (S.L., D.J.C., A.C., A.S., Z.Z., Y.L., B.R., J.F.G.).

4. Cardiovascular Surgery (L.C.), University Heart and Vascular Center Hamburg, Germany.

5. St. Francis Hospital, Roslyn, New York (D.J.C.).

6. University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, France (A.C.).

7. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, NY (A.S., A.L.).

8. Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University, Columbus (W.T.A.).

9. Structural Valve Program, Montreal Heart Institute, Canada (W.B.A.).

10. Los Robles Regional Medical Center, Thousand Oaks, CA (S.K.).

11. Bakersfield Heart Hospital, CA (S.K.).

12. Royal Brompton Hospital, London, United Kingdom (A.D.).

13. Division of Cardiology, University of Virginia, Charlottesville (D.S.L.).

14. Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M. Adamo, M.M.).

15. Department of Cardiology, Heart Center, University of Cologne, Germany (M. Adam).

16. NewYork-Presbyterian Hospital/Columbia University Medical Center (B.R.).

17. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.).

18. Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden (B.R.).

19. Cardiology Department, St. Vincent’s Hospital, Sydney, Australia (D.W.M.M.).

20. School of Clinical Medicine, UNSW Medicine and Health UNSW Sydney, Australia (D.W.M.M.).

21. St. Paul’s Hospital, Vancouver, British Columbia, Canada (J.G.W.).

22. Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Italy (A.S.P.).

23. Departments of Cardiovascular Surgery (H.R.), German Heart Center Munich, Germany.

24. Cardiovascular Surgery, INSURE–Institute for Translational Cardiac Surgery (H.R.), German Heart Center Munich, Germany.

25. Heart Center Bonn, Germany (G.N.).

26. Rigshospitalet, Copenhagen, Denmark (L.S.).

27. IRCCS Humanitas Research Hospital, Milan, Italy (D.R.).

28. IRCCS Policlinico San Donato, Milan, Italy (A.G.).

29. Medical Clinic II, University Heart Center Lübeck, Germany (T.S.).

30. Department of Cardiac Surgery, Medical University of Vienna, Austria (M. Andreas).

31. Oslo University Hospital, Rikshospitalet, Norway (G.D.).

32. Frankfurt University Hospital, Germany (T.W.).

33. German Heart Institute Berlin, Germany (J.K.).

34. Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY (G.H.L.T.).

35. St. Thomas’ Hospital, London, United Kingdom (S.R.).

36. HerzZentrum Hirslanden Zürich, Switzerland (M.T.).

37. Universitätsklinik für Kardiologie, Inselspital Bern, Switzerland (F.P.).

38. St. Michael’s Hospital, University of Toronto, Canada (N.F.).

39. Groupe CardioVasculaire Interventionnel, Clinique Pasteur Toulouse, France (N.D.).

40. Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France (J.-F.O.).

41. Heart Valve Center and Heart and Vascular Center, Universitätsmedizin Mainz, Germany (R.S.v.B.).

42. Department of Interventional and General Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Germany (T.K.R.).

43. Houston Methodist Hospital, TX (M.J.R.).

44. Ospedale San Raffaele, Milan, Italy (P.D.).

45. Baylor Scott and White Heart Hospital Plano, TX (M.J.M.).

46. Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany (J.H.).

47. Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, DC (F.M.A.).

48. Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.).

49. Centre Hospitalier Universitaire de Bordeaux, France (T.M.).

50. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.).

Abstract

Background: Transcatheter mitral valve replacement (TMVR) is an emerging therapeutic alternative for patients with secondary mitral regurgitation (MR). Outcomes of TMVR versus guideline-directed medical therapy (GDMT) have not been investigated for this population. This study aimed to compare clinical outcomes of patients with secondary MR undergoing TMVR versus GDMT alone. Methods: The CHOICE-MI registry (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) included patients with MR undergoing TMVR using dedicated devices. Patients with MR pathogeneses other than secondary MR were excluded. Patients treated with GDMT alone were derived from the control arm of the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation). We compared outcomes between the TMVR and GDMT groups, using propensity score matching to adjust for baseline differences. Results: After propensity score matching, 97 patient pairs undergoing TMVR (72.9±8.7 years; 60.8% men; transapical access, 91.8%) versus GDMT (73.1±11.0 years; 59.8% men) were compared. At 1 and 2 years, residual MR was ≤1+ in all patients of the TMVR group compared with 6.9% and 7.7%, respectively, in those receiving GDMT alone (both P <0.001). The 2-year rate of heart failure hospitalization was significantly lower in the TMVR group (32.8% versus 54.4%; hazard ratio, 0.59 [95% CI, 0.35–0.99]; P =0.04). Among survivors, a higher proportion of patients were in the New York Heart Association functional class I or II in the TMVR group at 1 year (78.2% versus 59.7%; P =0.03) and at 2 years (77.8% versus 53.2%; P =0.09). Two-year mortality was similar in the 2 groups (TMVR versus GDMT, 36.8% versus 40.8%; hazard ratio, 1.01 [95% CI, 0.62–1.64]; P =0.98). Conclusions: In this observational comparison, over 2-year follow-up, TMVR using mostly transapical devices in patients with secondary MR was associated with significant reduction of MR, symptomatic improvement, less frequent hospitalizations for heart failure, and similar mortality compared with GDMT. Registration: URL: https://clinicaltrials.gov ; Unique identifier: NCT04688190 (CHOICE-MI) and NCT01626079 (COAPT).

Funder

Deutsche Herzstiftung

Abbott Laboratories

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

Reference22 articles.

1. Survival and Cardiovascular Outcomes of Patients With Secondary Mitral Regurgitation

2. Secondary Mitral Regurgitation in Heart Failure

3. Transcatheter Mitral-Valve Repair in Patients with Heart Failure

4. 3-Year Outcomes of Transcatheter Mitral Valve Repair in Patients With Heart Failure

5. Transcatheter Mitral Valve Replacement for Patients With Symptomatic Mitral Regurgitation

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