High-risk patients undergoing transcatheter mitral valve repair experience similar outcomes to patients who undergo traditional surgery.
Survival rates with catheter-based mitral valve repair are comparable to open surgery and better than conservative management in high-surgical-risk patients with severe mitral valve regurgitation.
Contemporary studies show that high-risk patients showed have similar survival at 1 year follow-up among mitral valve (MV) repair and surgery patients at 85%, and poorer survival among conservatively treated patients about 67.6%. (Swaans MJ et al),
In the above study the same trend was seen in the second and third years of follow-up, with 62.3% of MV repair patients still living after 3 years, compared with 54.2% of conservatively treated patients.
Mitral valve regurgitation, mitral insufficiency, refers to the reversal of blood flow from the left ventricle to the left atrium, and is the most common form of heart valve disease.
Patients with symptomatic MR have a poor prognosis, even with optimal medical therapy, there is no survival benefit associated with nonsurgical medical management.
Many patients are not referred for surgery because they are considered poor surgical candidates due to advanced age, left ventricular dysfunction, or other comorbidities.
Transcatheter mitral valve repair involves the creation of a double MV orifice by means of a clip in the mid portion of the anteromedial and posterolateral leaflets.
In a study of 139 consecutive patients treated with transcatheter MV repair, with outcomes compared with 53 surgically treated and 59 conservatively treated patients who were identified retrospectively; Survival rates among patients who received MV repair and surgery were better than that of conservatively treated patients at 1, 2 and 3-year follow-up.
Transcatheter mitral valve repair for degenerative MR uses an edge to edge microvalve leaflet repair technique.
Outcomes of transcatheter mitral valve repair for high risk surgical patients and isolated degenerative MR results in successful repair in almost 89% of patients (Makkah RR).
Isolated secondary mitral regurgitation causes symptoms and patients with heart failure and is associated with increase morbidity and mortality.
Among patients with heart failure and moderate to severe or severe secondary mitral regurgitation, who remain symptomatic, despite medical therapy, transcatheter edge to edge repair of the mitral valve, was safe and led to a lower rate of hospitalization for heart failure, and lower all cause mortality, through five years of follow up than medical therapy alone (Stone GW).
Among patients with heart failure with moderate to severe functional mitral regurgitation who receive medical therapy, addition of transcatheter, mitral valve repair, led to a lower rate of or recurrent hospitalization for heart failure for cardiovascular death and lower rate of first or recurrent hospitalization for heart failure at 24 months and better health status at 12 months than medical therapy alone open(RESHAPE – HF2 investigators).
Among patients with heart failure and secondary mitral regurgitation, transcatheter edge to edge repair is non-inferior to mitral valve surgery with respect to death, rehospitalization for heart failure, stroke, reinvention, or implantation of an assist device in the left ventricle at one year (MATTERHORN investigators).