WHAT IS KNOWN? Although mitral TEER is widely performed in patients with severe primary and secondary MR, the impact of MR
New Research PaperStructuralImpact of Mitral Regurgitation Etiology on Mitral Surgery After Transcatheter Edge-to-Edge Repair: From the CUTTING-EDGE Registry
Central Illustration
Section snippets
Data Source
The CUTTING-EDGE registry is a multicenter, international registry of patients who underwent MV surgery after TEER.4 Patients who underwent MV surgery between July 2009 and July 2020 after TEER were included across 34 centers worldwide. Anonymized data were obtained from each institution's electronic health records and transmitted to a central site for data management and statistical analyses. Because all institutions contributed cases after obtaining local institutional review board approvals,
Baseline Clinical, Procedural and Echocardiographic Characteristics at Index TEER
A total of 330 patients underwent MV surgery following TEER in the CUTTING-EDGE registry during the study period, of which 155 patients (47%) had PMR and 175 patients (53%) SMR. Temporal trends in annual MV surgery cases stratified by MR etiology are illustrated in Figure 1. The mean age at the time of index TEER procedure was 73.8 ± 10.1 years, and 42.7% were female (Table 1). Median STS risk score was 4.0% (IQR: 2.2%-7.3%), 48.0% were deemed high or extreme surgical risk by the local heart
Discussion
This analysis from the CUTTING-EDGE registry examined the impact of initial MR etiology on MV surgery outcomes after a failed TEER procedure, and has several key findings (Central Illustration). First, compared with PMR, SMR patients exhibited a significantly higher 1-year mortality and a lower cumulative survival at 3 years after surgery, despite no differences in the scenario of TEER failure and timing of surgery. We can speculate that this was mainly due to the greater comorbidity burden in
Conclusions
In this report from the international CUTTING-EDGE registry, patients with SMR undergoing MV surgery for TEER failure had more operations for mitral stenosis, with fewer MV repair and worse prognosis compared with those with PMR. Our findings are hypothesis generating and will provide further insights into patients after TEER who may require MV surgery in the future.
Funding Support and Author Disclosures
Dr Bhadra has received travel compensation from Edwards Lifesciences. Dr Tagliari has received research support from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. Dr Leurent has been a consultant and physician proctor for and has received speaker honoraria from Abbott. Dr Asgar has been a consultant for Medtronic, Abbott, Edwards Lifesciences, and W. L. Gore & Associates; and has received research grants from Abbott. Dr Leroux has been a physician proctor for Medtronic and
Acknowledgments
The authors thank all the coinvestigators for their participation and involvement in the CUTTING-EDGE registry. The names are listed in the Supplemental Appendix.
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Drs Zaid and Avvedimento contributed equally to this work.