Abstract 14349: Transcatheter Edge-to-Edge Mitral Repair versus Surgery in Medicare Patients

Abstract

Background: The optimal therapy for patients with primary mitral regurgitation eligible for transcatheter mitral edge-to-edge repair (TEER) and surgery is not known. This study compared mid-term outcomes of TEER and mitral surgery for primary mitral regurgitation. Methods: Centers for Medicare and Medicaid data was used to identify 158,931 adults who underwent mitral repair (42.9%, n=68,166) or TEER (14.5%, n=23,008) between July 2012 and June 2019. Patients undergoing mitral replacement (42.6%, n=67,757), previous mitral intervention (3.1%, n=4877), secondary, rheumatic or infectious etiology (26.3%, n=41,821), coronary or valve surgery (22.2%, n=35,438), and urgent procedures (15.6%, n=24,768) were excluded, and 4550 propensity matched patient pairs created. The primary outcome was 3-year survival. Stroke and mitral re-intervention were compared using competing risk analysis, with a landmark analysis of new atrial fibrillation (AF) after 30-days. Results: In the overall cohort patients undergoing TEER were older, with worse comorbidity and frailty than patients undergoing surgery. In propensity matched patients mean age was 77.3 vs. 76.4 years (P=NS) and frailty score was 0.2 vs. 0.19 (P=NS). Three-year mortality after surgery was 14% (standard error (SE) 0.02) versus 34% (standard error (SE) 0.03) after TEER (p<0.0001) (Figure). In competing risk analysis at three years stroke rates were similar (hazard ratio (HR) 1.07, 95% confidence interval (CI) 0.80-1.45), mitral reintervention was less common (HR 0.26, 95% CI 0.20-0.34); new AF was significantly less common (HR 0.82, 95% CI 0.7-0.96) after surgical repair compared to TEER. Conclusion: In propensity matched patients with primary mitral regurgitation surgical mitral repair was associated with superior survival, freedom from new AF and mitral re-intervention. This treatment difference, which may be due to selection bias, should be evaluated in randomized trials.