603 Comparison of Surgical and Transcatheter Edge-to-Edge Mitral Valve Repair in Patients With Left Ventricular Dysfunction

Abstract

A comparison of minimally invasive mitral valve repair (MIMVR) and transcatheter edge-to-edge repair (TMVR) on ventricular remodelling in patients with pre-existing left ventricular systolic dysfunction (LVEF≤50%) has not previously been reported. This study compares the immediate and short-term echocardiographic outcomes of MIMVR and TMVR. This is a single-center, retrospective, observational cohort study of patients with an LVEF≤50% who underwent MIMVR or TMVR between February 2008-August 2018. Baseline and postoperative TTE’s (pre-discharge; 3 months) were analysed by two-blinded independent investigators. Eighty-three patients (33 MIMVR; 50 TMVR; 76 [19] years) with grade 3-4 MR and an LVEF≤50% underwent MIMVR or TMVR. Less than 2+MR was achieved in 97% of MIMVR patients with a corresponding reduction in LVEDVI (Pre-70±23mLs/m2; Post-53mLs±17mLs/m2; p<0.01). Ninety-two percent of TMVR patients had ≤2+MR pre-discharge, albeit with no significant post-procedural reduction in LVEDVI (Pre-81±43mLs/m2; Post-81±42mLs/m2; p=0.52). At 3-months in the TMVR cohort, ≤1+MR remained in 71% of patients whilst 10% had ≥3+MR. There was a transient decline in LVEF in both cohorts, however this recovered to baseline at 3-months. Both cohorts demonstrated a reduction in pulmonary artery systolic pressure at 3-months (MIMVR post-28±7mmHg, p=0.13; TMVR post-41±16mmHg, p<0.01) and a trend towards improved RVFAC albeit not statistically significant. Surgical MIMVR is more effective than TMVR in correcting MR and reducing LV volumes in patients with pre-existing LV dysfunction. These findings raise the possibility that valve annuloplasty, in addition to repair, is an important component of remodelling and may help to guide future transcatheter device selection.