Transcatheter versus Open Mitral Valve Repair

Authors

Benjamin CrumleyFollow

Advisor

Dr. Watkins

Abstract

Objective: The purpose of this article is to compare the outcomes of transcatheter mitral valve repair (TMVr) using the MitraClip© and open surgical mitral valve repair.¹

Method: The method performed was a literature review with PubMed, Google Scholar, and Medline conducted using the search terms transcatheter mitral valve repair.

Results: The thirty-day operative mortality for TMVr and open repair were 6% and 16% respectively (95% CI, p-value of -0.01). ² For postoperative CVA, TMVr and open repair revealed 3% and 4%, respectively (95% CI).² The survival rates at one year for TMVr and open repair were 69% and 67%, and at 5 years were 23% and 29%, respectively (95% CI).²

At five years follow-up, the combination of freedom from death, surgery, or 3+ or 4+ MR in the as-treated population was 44.2% versus 64.3% in the TMVr and open repair groups, respectively (p = 0.01).³ There was no significant difference in mortality (open repair 20.8% vs. TMVr 26.8%; p = 0.36). The TMVr group did experience more surgery or reoperation (27.9% vs. 8.9%; p = 0.003) and more 3+ or 4+ MR (12.3% vs. 1.8%; p = 0.02). Freedom from death and surgery for the TMVr and the open repair group was found to be 60.6% and 73.3% respectively (p = 0.03). The majority of surgeries occurred in the first 6 months (33 out of 43). This difference was not found at 6 months to 5 years (77.7% TMVr vs. 76.2% open repair; p = 0.77). At 5 years, 3+ or 4+ MR was 2.5% for open repair versus 18.8% for TMVr; p = 0.01). The New York Heart Association (NYHA) functional class III/IV symptoms were similar at 1 year and 5 years (TMVr 7.5% vs. open repair 1.0%; p = 0.03 at 1 year and 8.6% and 2.5% p = 0.19 at 5 years).³

Conclusion: If a patient is a prohibitive risk for open-heart surgery, having a TMVr with the MitraClip© would be as beneficial as open-heart surgery in regards to mortality even if a post-TMVr patient remains with 3+ to 4+ MR post-procedure.³ Continued follow-up will assist to further our knowledge of the TMVr procedure and its outcomes.

Recommended Citation

Crumley B. Transcatheter versus Open Mitral Valve Repair. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2020; 2(1).