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Kaneko T, Newell PC, Nisivaco S, Yoo SGK, Hirji SA, Hou H, Romano M, Lim DS, Chetcuti S, Shah P, Ailawadi G, Thompson M. Incidence, characteristics, and outcomes of reintervention after mitral transcatheter edge-to-edge repair. J Thorac Cardiovasc Surg 2024; 167:143-154.e6. [PMID: 35570022 DOI: 10.1016/j.jtcvs.2022.02.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/20/2022] [Accepted: 02/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The use of transcatheter edge-to-edge repair (TEER) is growing substantially, and reintervention after TEER by way of repeat TEER or mitral valve surgery (MVS) is increasing as a result. In this nationally representative study we examined the incidence, characteristics, and outcomes of reintervention after index TEER. METHODS Between July 2013 and November 2017, we reviewed 11,396 patients who underwent index TEER using Medicare beneficiary data. These patients were prospectively tracked and identified as having repeat TEER or MVS. Primary outcomes included 30-day mortality, 30-day readmission, 30-day composite morbidity, and cumulative survival. RESULTS Among 11,396 patients who underwent TEER, 548 patients (4.8%) required reintervention after a median time interval of 4.5 months. Overall 30-day mortality was 8.6%, 30-day readmission was 20.9%, and 30-day composite morbidity was 48.2%. According to reintervention type, 294 (53.7%) patients underwent repeat TEER, and 254 (46.3%) underwent MVS. Patients who underwent MVS were more likely to be younger and female, but had a similar comorbidity burden compared with the repeat TEER cohort. After adjustment, there were no differences in 30-day mortality (adjusted odds ratio [AOR], 1.26 [95% CI, 0.65-2.45]) or 30-day readmission (AOR, 1.14 [95% CI, 0.72-1.81]). MVS was associated with higher 30-day morbidity (AOR, 4.76 [95% CI, 3.17-7.14]) compared with repeat TEER. Requirement for reintervention was an independent risk factor for long-term mortality in a Cox proportional hazard model (hazard ratio, 3.26 [95% CI, 2.53-4.20]). CONCLUSIONS Reintervention after index TEER is a high-risk procedure that carries a significant mortality burden. This highlights the importance of ensuring procedural success for index TEER to avoid the morbidity of reintervention altogether.
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Affiliation(s)
- Tsuyoshi Kaneko
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Paige C Newell
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sarah Nisivaco
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sang Gune K Yoo
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Sameer A Hirji
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Matthew Romano
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - D Scott Lim
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Va
| | - Stan Chetcuti
- Department of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Pinak Shah
- Division of Cardiology, Brigham and Women's Hospital, Boston, Mass
| | - Gorav Ailawadi
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Michael Thompson
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
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Wagner CM, Schultz ML, Brescia AA, Wang Y, Fu W, Hawkins RB, Romano MA, Ailawadi G, Bolling SF. Surgical outcomes of patients at prohibitive risk who are reconsidered for surgery. JTCVS OPEN 2023; 16:234-241. [PMID: 38204727 PMCID: PMC10775058 DOI: 10.1016/j.xjon.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/07/2023] [Accepted: 08/28/2023] [Indexed: 01/12/2024]
Abstract
Objectives Transcatheter treatment of advanced mitral and tricuspid valve disease is largely limited to patients at prohibitive surgical risk, although many are not candidates for transcatheter treatment. Here, we describe surgical outcomes of patients at prohibitive risk who were ineligible for transcatheter therapies to guide surgeons in management of this unique population. Methods Patients at prohibitive risk, defined per surgeon or cardiologist discretion, who were initially referred for a transcatheter mitral or tricuspid intervention in a multidisciplinary atrioventricular valve clinic, were identified from 2019 to 2022. Preoperative risk, operative outcomes, and long-term mortality were evaluated. Results A total of 337 patients at prohibitive risk were referred for evaluation in a multidisciplinary atrioventricular valve clinic. Of those, 161 underwent transcatheter therapy, 130 patients underwent continued medical management, and 45 were reevaluated and had high-risk surgery. Among surgical patients, 51% were women with a median age of 76 years (quartile 1-quartile 3, 65-81 years). Most patients presented in heart failure (83%; n = 37 out of 45), and 73% were in New York Heart Association functional class III or IV. Most patients (94%; n = 43) had a mitral valve intervention, of whom 56% (24 out of 43) had a mitral valve replacement. The 30-day mortality rate was 4% (2 out of 45) and major morbidity occurred in 33% (15 out of 45). By Kaplan-Meier analysis, 1-year survival was 86% ± 9%. Conclusions Select patients at prohibitive risk who were ineligible for transcatheter mitral or tricuspid valve intervention underwent surgery with overall low operative mortality and excellent 1-year survival. Patients a prohibitive risk whose anatomy is not amenable to transcatheter devices should be reconsidered for surgery.
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Affiliation(s)
| | - Megan L. Schultz
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | | | - Yoyo Wang
- University of Michigan Medical School, Ann Arbor, Mich
| | - Whitney Fu
- Department of General Surgery, University of Michigan, Ann Arbor, Mich
| | - Robert B. Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Matthew A. Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Steven F. Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Michigan Mitral Research Group
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
- University of Michigan Medical School, Ann Arbor, Mich
- Department of General Surgery, University of Michigan, Ann Arbor, Mich
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El-Eshmawi A, Costa AC, Boateng P, Pandis D, Israel Y, Adams DH, Tang GHL. Mitral valve surgery after failed transcatheter edge-to-edge repair: a review and word of caution. Curr Opin Cardiol 2023; 38:143-148. [PMID: 36200272 DOI: 10.1097/hco.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW As transcatheter edge-to-edge mitral valve repair (TEER) evolves and indications broaden to include younger and lower surgical risk patients, it is essential to understand TEER failure trends and potential impact on subsequent mitral valve surgery, especially when pertaining to feasibility of durable valve reconstruction as opposed to de-novo repair. RECENT FINDINGS Results of the two largest series analysing mitral valve surgery following TEER have demonstrated remarkably low repairability rates with consequent need for valve replacement. Post TEER surgery was associated with high early and late mortalities, likely as a reflection of patient baseline characteristics and acuity of surgery. Presence and correction of concomitant cardiac pathologies were a frequent finding. Centre and surgeon volumes were important factors in optimizing the likelihood of salvage repair and reducing perioperative risks. SUMMARY Surgical mitral valve repair in reference centres remain the gold standard and the most durable treatment for degenerative mitral disease with excellent perioperative safety outcomes. Given the high likelihood of needing high-risk mitral valve replacement when TEER fails, consideration for potentially less durable transcatheter alternatives should be taken with caution in younger or lower surgical risk patients.
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Affiliation(s)
| | | | - Percy Boateng
- Department of Cardiovascular Surgery, Mount Sinai Hospita
| | | | - Yonatan Israel
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David H Adams
- Department of Cardiovascular Surgery, Mount Sinai Hospita
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Inci EK, Greenbaum AB, Lederman RJ, Kohli K, Lisko JC, Byku I, Gleason PT, Xie JX, Shekiladze N, Babaliaros VC. Transcatheter Electrosurgical Laceration and Stabilization of Failed MitraClip[s]/SAPIEN M3 for Treatment of Failed MitraClip. Circ Cardiovasc Interv 2022; 15:e012014. [PMID: 35580205 DOI: 10.1161/circinterventions.122.012014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Errol K Inci
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (R.J.L.)
| | - Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, Atlanta (K.K.)
| | - John C Lisko
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Isida Byku
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Patrick T Gleason
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Joe X Xie
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Nikoloz Shekiladze
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
| | - Vasilis C Babaliaros
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA (E.K.I., A.B.G., J.C.L., I.B., P.T.G., J.X.X., N.S., V.C.B.)
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Sticchi A, Praz F, Reineke D, Windecker S. Learning From Failure at the CUTTING-EDGE of Transcatheter Mitral Valve Therapies. JACC Cardiovasc Interv 2021; 14:2022-2026. [PMID: 34556276 DOI: 10.1016/j.jcin.2021.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Alessandro Sticchi
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
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Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair: Mid-Term Outcomes From the CUTTING-EDGE International Registry. JACC Cardiovasc Interv 2021; 14:2010-2021. [PMID: 34556275 DOI: 10.1016/j.jcin.2021.07.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022]
Abstract
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.
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