Surgical Mitral Valve Repair vs Replacement After Failed Mitral Transcatheter Edge-to-Edge Repair: The CUTTING-EDGE Registry.

Authors

• Mateo Marin-Cuartas
• Jagdip Kang
• Thilo Noack
• Manuela de la Cuesta
• Markus Krane
• Volkmar Falk
• Lenard Conradi
• Christian Hagl
• Maurizio Taramasso
• Tom C Nguyen
• D Scott Lim
• Gorav Ailawadi
• Michael J Mack
• Robert L Smith
• Anita W Asgar
• Kendra J Grubb
• Luigi Pirelli
• Paolo Denti
• Thomas Modine
• Michael J Reardon
• Tamim M Nazif
• Vinayak N Bapat
• Tsuyoshi Kaneko
• Philipp Kiefer
• Michael A Borger
• Gilbert H L Tang
• Syed Zaid

Language

English

Publication Date

4-14-2025

Journal

JACC: Cardiovascular Interventions

DOI

10.1016/j.jcin.2025.02.008

PMID

40240085

Abstract

Background: The impact of mitral valve (MV) surgery type after failed mitral transcatheter edge-to-edge repair (M-TEER) has not been well studied.

Objectives: The aim of this study was to compare the outcomes of MV repair vs replacement after failed M-TEER.

Methods: From 2009 to 2020, a total of 332 patients across 34 centers from the CUTTING-EDGE registry underwent MV surgery after M-TEER. Outcomes were compared between MV repair and replacement. Primary outcomes included 30-day mortality and 1-year survival after MV surgery.

Results: Among enrolled patients (mean age 73.8 ± 10.1 years, median Society of Thoracic Surgeons Predicted Risk of Mortality 3.9% [Q1-Q3: 2.2%-6.8%]), 25 (7.5%) underwent repair and 307 (92.5%) underwent replacement. The replacement group had a significantly higher rate of comorbidities, including atrial fibrillation, prior cardiac surgery, more secondary mitral regurgitation, and more devices implanted at index M-TEER (P < 0.05 for all). Replacement patients showed a trend toward higher 30-day mortality (17.7% [52 of 294] vs 4.0% [1 of 25]; P = 0.094). The observed-to-expected ratio of 30-day mortality was 3.6 (95% CI: 1.9-5.3) overall, 3.8 (95% CI: 2.1-5.5) in the replacement group, and 1.7 (95% CI: 0.7-3.3) in the repair group. Replacement patients had higher 1-year mortality (33.3% [65 of 195] vs 10.5% [2 of 19]; P = 0.041). Significantly lower survival rates were observed after replacement at 2 years (P = 0.033) and persisted in the risk-adjusted Cox regression analysis (HR for replacement: 4.24; 95% CI: 1.04-17.31; P = 0.044).

Conclusions: MV surgery after failed M-TEER is a high-risk procedure associated with higher than expected 30-day mortality, with higher mortality associated with MV replacement. Compared with repair, replacement is associated with higher 1-year mortality and a lower 2-year survival.

Keywords

Humans, Registries, Male, Aged, Female, Time Factors, Mitral Valve, Heart Valve Prosthesis Implantation, Mitral Valve Insufficiency, Risk Factors, Aged, 80 and over, Risk Assessment, Cardiac Catheterization, Mitral Valve Annuloplasty, Treatment Outcome, United States, Treatment Failure, Middle Aged, Retrospective Studies, Recovery of Function, mitral valve repair, mitral valve replacement, mitral valve surgery, transcatheter edge-to-edge repair

Published Open-Access

yes

Recommended Citation

Marin-Cuartas, Mateo; Kang, Jagdip; Noack, Thilo; et al., "Surgical Mitral Valve Repair vs Replacement After Failed Mitral Transcatheter Edge-to-Edge Repair: The CUTTING-EDGE Registry." (2025). Faculty, Staff and Students Publications. 6879.
https://digitalcommons.library.tmc.edu/baylor_docs/6879