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Surgery and Transcatheter Intervention for Degenerative Mitral Regurgitation in The United States

Wednesday, January 24, 2024

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Joanna Chikwe, Qiudong Chen, Michael E Bowdish, Amy Roach, Dominic Emerson, Annetine Gelijns, Natalia Egorova

In this article, the authors evaluated the practice trends and three-year outcomes following transcatheter edge-to-edge repair (TEER) and surgical repair for degenerative MR in the United States. Medicare and Medicaid data of 53,117 mitral valve interventions for degenerative MR (surgery or TEER) between 2012 and 2019 were analyzed. After excluding patients with rheumatic and congenital disease, endocarditis, myocardial infarction, cardiomyopathy, and concomitant or prior coronary revascularizations, a total of 27,170 patients remained in the analysis.

The total annual volume of mitral interventions did not significantly change (p=0.18) during the study period. However, surgical cases decreased by a third while TEER increased. The included patients were 52.5 percent male and had a mean age of 73.5 years. A total of 7,755 patients underwent TEER, and 19,415 underwent surgical repair. Surgical patients were younger (p <0.001), with less comorbidity and frailty. After matching for baseline characteristics, the resulting 4,532 patient pairs presented with a three-year survival rate after TEER of 65.9 percent (95 percent CI 64.3-67.6) and 85.7 percent (95 percent CI 84.5-86.9) after surgery (p <0.001). The three-year stroke rates after TEER or surgery were 1.8 percent (95 percent CI 1.5-2.2) and 2.0 percent (95 percent CI 1.6-2.4) (p=0.49), respectively. The three-year heart failure readmission rates after TEER or surgery were 17.8 percent (95 percent CI 16.7-18.9) and 11.2 percent (95 percent CI 10.3-12.2 and p <0.001), respectively. Finally, the three-year mitral reintervention rates after TEER or surgery were 6.1 percent (95 percent CI 5.5-6.9) and 1.3 percent (95 percent CI 1.0-1.7 and p<0.001), respectively.


I am certain that this does not come as a surprise to anyone who has ever surgically repaired a mitral valve. What does surprise me is how little our societies have done to get the message out to the general public! TEER should be a palliative procedure reserved for patients who cannot have surgery!!! The safety, and quality of life benefits of surgical repair need to be publicized to the maximum extent! It is time that we take the bull by the horns, and stop permitting cardiologists to go on peddling an inferior procedure to an uninformed general public!!! TEER outcomes would NEVER stand the scrutiny of our own QI processes! Why then are we so idly standing by, and continue to let this happen! LETS TAKE OFF THE GLOVES!!!!!!
Well done study which shows the truth and facts of the superiority of surgery for this group of patients over TEER. Unfortunately the cardiologists are supported by a multi billion dollars industry while we surgeons stand alone supported by the true results if Well done studies. The only publicity will come from more studies and more publications.

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