Mitral Valve Surgery After Failed Transcatheter Edge-to-Edge Repair: A Meta-Analysis

IF 5.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology Pub Date : 2025-05-01 DOI:10.1016/j.cjca.2025.02.010

Francesco Cabrucci MD , Massimo Baudo MD , Dimitrios E. Magouliotis MD, MSc, PhD , Yoshiyuki Yamashita MD, PhD , Stephanie Kjelstrom MPH , Beatrice Bacchi MD , Massimo Bonacchi MD , Aleksander Dokollari MD, PhD , Serge Sicouri MD , Basel Ramlawi MD

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引用次数: 0

Abstract

Background

Transcatheter edge-to-edge repair (TEER) is increasingly used for mitral regurgitation (MR), particularly in high-risk patients. However, when TEER fails, patients often require mitral valve surgery, which remains challenging because of patients' compromised condition. This study aims to evaluate short- and long-term surgical outcomes following failed TEER.

Methods

This meta-analysis included observational studies with reported outcomes of mitral valve surgery after failed TEER published until September 2024. Multivariable meta-regressions were performed to predict short- and long-term mortality. Kaplan-Meier function was reconstructed from individual studies.

Results

Sixteen studies were included with a total sample of 892 patients. The mean age was 74.8 years (55% males), with most patients (87.8%) in New York Heart Association class III or IV before surgery. Pooled mean Society of Thoracic Surgeons (STS) predicted risk of mortality score before index TEER was 6.3%. Surgical indications were recurrent MR ≥3+ (93%), mitral stenosis (17%), and endocarditis (2.7%). The average time between TEER and surgery was 6.4 months. Mitral valve replacement was performed in 83.8% of cases. Thirty-day all-cause mortality was 12.2% but significantly lower for elective cases (2.5%). At a mean follow-up of 14.7 months, mortality was 28.3%. Preoperative incidence of coronary artery disease, lower left ventricle ejection fraction (LVEF), rate of concomitant procedures, and functional mitral regurgitation were predictors of short- and long-term outcomes.

Conclusion

Mitral valve surgery after failed TEER presents significant challenges, yet acceptable outcomes are achievable, particularly in elective cases. Complete treatment of concomitant lesions may improve outcomes in patients with preserved LVEF. Future research should stratify outcomes based on emergent vs elective surgery and MR etiology to guide tailored surgical strategies.

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经导管边缘对边缘修复失败后二尖瓣手术- meta分析。

背景：经导管边缘到边缘修复（TEER）越来越多地用于二尖瓣反流（MR），特别是在高危患者中。然而，当TEER失效时，患者通常需要二尖瓣手术，由于患者的病情受损，这仍然具有挑战性。本研究旨在评估TEER失败后的短期和长期手术结果。方法：本荟萃分析纳入了截至2024年9月发表的关于二尖瓣手术失败的观察性研究。采用多变量元回归预测短期和长期死亡率。从个体研究中重建Kaplan-Meier函数。结果：纳入16项研究，共纳入892例患者。平均年龄74.8岁（55%为男性），术前NYHA III/IV期患者最多（87.8%）。合并后的平均STS-PROM评分为6.3%。手术指征为复发性MR≥3+(93%)、二尖瓣狭窄（17%）和心内膜炎（2.7%）。从TEER到手术的平均时间为6.4个月。83.8%的病例行二尖瓣置换术。30天全因死亡率为12.2%，但择期病例明显较低（2.5%）。平均随访14.7个月，死亡率为28.3%。术前冠心病发生率、低LVEF、合并手术率和功能性二尖瓣反流是短期和长期预后的预测因素。结论：TEER失败后的二尖瓣手术面临着巨大的挑战，但可接受的结果是可以实现的，特别是在选择性病例中。完全治疗伴发病变可改善保留LVEF患者的预后。未来的研究应根据紧急手术与选择性手术和MR病因学对结果进行分层，以指导量身定制的手术策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Journal of Cardiology 医学-心血管系统

CiteScore

9.20

自引率

8.10%

发文量

546

审稿时长

32 days

期刊介绍： The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.