Impact of mitral valve treatment choice on mortality according to aetiology

EuroIntervention 2019;14:1733-1739 published online December 2018. DOI: 10.4244/EIJ-D-18-00874

Friso Kortlandt
Friso Kortlandt1*, MD; Juliette Velu2, MSc; Remco Schurer3, MD; Ben Van den Branden4, MD, PhD; Berto Bouma2, MD, PhD; Johannes Kelder1, MD, PhD; Frank Eefting1, MD; Martin Swaans1, MD, PhD; Benno Rensing1, MD, PhD; Jan Baan Jr2, MD, PhD; Jan Van der Heyden1, MD, PhD
1. St. Antonius Hospital, Nieuwegein, the Netherlands; 2. Academic Medical Center, Amsterdam, the Netherlands; 3. University Medical Center, Groningen, the Netherlands; 4. Amphia Hospital, Breda, the Netherlands

Aims: Treatment strategies of high-risk patients with mitral regurgitation (MR) differ between disease based on functional and disease based on degenerative origin. In the present study, we aimed to evaluate the effect of surgical, percutaneous, or conservative treatment of MR according to MV mechanism, for high-risk patients.

Methods and results: Survival outcomes of MitraClip, surgical, or conservative strategies were compared for 688 high-risk patients with functional MR and 275 with degenerative MR. Cox regression and propensity analyses were used to correct for differences in baseline characteristics. For functional MR, conservative treatment proved to have a higher mortality hazard when compared to MitraClip treatment (hazard ratio [HR] 1.79, 95% confidence interval [CI]: 1.34 to 2.39, p<0.001), while there was no significant difference in mortality hazard between MitraClip and surgery (HR 0.86, 95% CI: 0.54 to 1.38, p=0.541). For degenerative MR, no clear significant benefit was found when comparing MitraClip to conservative and surgical treatment.

Conclusions: High-risk patients with symptomatic functional MR have reduced mortality when undergoing MitraClip intervention, compared to those receiving conservative treatment.

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clinical trialdeathmitral regurgitationmitral valve repair
Interventions for valvular diseaseInterventions for heart failurePeripheral interventionsMitral valve replacement and repairChronic heart failureIliac / Femoral / Popliteal
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