Abstract | December 19, 2022

Outcomes of Patients with Mitral Regurgitation and concomitant Aortic and Tricuspid Valve Disease after Transcatheter Edge-to-Edge Mitral Valve Repair

Presenting Author: Kristina Menchaca, MD, Internal Medicine Resident, PGY3, Department of Internal Medicine, University of Miami, Miami, Florida

Coauthors: Catherine Ostos Perez, MD, Internal Medicine, PGY3, University of Miami-Palm Beach, Miami, FL; Nemanja Draguljevic, MD, Internal Medicine, Medical Student, University of Belgrade, Belgrade, SRB; Guo Cheng, MD, Assistant Project Scientist, University of California, Los Angeles, CA; Fergie Losiniecki, MD, Cardiology, Cardiology Fellow, University of Miami-Palm Beach, Miami, FL; Marcos Nores, MD, Cardiothoracic Surgeon, Cardiothoracic Surgery, JFK Medical Center, Atlantis, FL; and Robert Chait, MD, Program Director, Cardiology, University of Miami-Palm Beach, Miami, FL.

Learning Objectives

  1. Short-term outcomes of octogenarians and nonagenarians with concomitant aortic and tricuspid valve pathology were referred to TEER instead of surgery.
  2. This warrants future studies to address the use of TEER in patients with complicated valve pathologies and their long-term outcomes

Background: Patients with severe mitral valve regurgitation (MVR) and coincidental aortic or tricuspid valve disease represent a management challenge. Traditionally, if an interdisciplinary heart team decides to perform open-heart surgery to replace the mitral valve, aortic stenosis or regurgitation are usually corrected simultaneously. However, patients at high surgical or prohibitive risks are usually referred to a less invasive alternative such as transcatheter edge-to-edge mitral valve repair (TEER) for severe mitral valve regurgitation. We decided to observe the outcomes of the patients who underwent TEER for severe mitral valve regurgitation associated with aortic or tricuspid valve disease. 

 

Methods: In this retrospective cohort study, we participated 170 patients that underwent TEER. Patients only with severe MVR 73/170 (42.9%) were compared to patients who had associated either moderate to severe aortic stenosis or regurgitation or tricuspid insufficiency 97/170 (57.1%). The patients had similar basic characteristics in terms of gender, prior diseases such as stroke, peripheral arterial disease, diabetes, heart failure, chronic lung disease, KCCQ12 score, MR severity, and ejection fraction. We assessed the impact of coincidental aortic or tricuspid valve disease on post-TEER outcomes such as MR reduction, total-in-hospital stay, and mortality.

 

Results:  Post-TEER,  no difference was found in reducing the severity of MR (p=0.91.), total-in-hospital stay (p=0.77), and survival between patients with only MVR and patients with MVR associated with either aortic stenosis or regurgitation or tricuspid insufficiency. Both groups exhibited a reduction in the severity of MR, average total in-hospital stay of 6.33~ 6.73 (mean 6.53), and survival of 100% compared to another group with good outcomes. 

 

Conclusions: There was no difference in feasibility and shorth term outcomes of TEER in patients only with MVR compared to patients with MVR and associated aortic or tricuspid valve disease. In the era of minimally invasive procedures such as TEER, when performed in patients with concomitant and very often complicated valve pathology, we need large-scale trials to follow up on these patients’ short- and long-term outcomes.

 

References:

  1. Lee CW, Sung SH, Huang WM, Tsai YL, Chen HY, Hsu CP, et al. Can Elderly Patients with Severe Mitral Regurgitation Benefit from Trans-catheter Mitral Valve Repair? Korean Circ J. 2019 Feb 20;49(6):532–41.
  2. Feldman T, Kar S, Elmariah S, Smart SC, Trento A, Siegel RJ, et al. Randomized Comparison of Percutaneous Repair and Surgery for Mitral Regurgitation: 5-Year Results of EVEREST II. Journal of the American College of Cardiology. 2015 Dec 29;66(25):2844–54.
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