Contemporary Treatment and Outcomes of High Surgical Risk Mitral Regurgitation
Before the development of transcatheter interventions, patients with mitral regurgitation (MR) and high surgical risk were often conservatively treated and subject to poor prognoses. We aimed to assess the therapeutic approaches and outcomes in the contemporary era. The study participants were conse...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/8/2978 |
| _version_ | 1797604874374873088 |
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| author | Mitsumasa Sudo Vivian Vij Nihal Wilde Tetsu Tanaka Johanna Vogelhuber Miriam Silaschi Marcel Weber Farhad Bakhtiary Georg Nickenig Sebastian Zimmer Atsushi Sugiura |
| author_facet | Mitsumasa Sudo Vivian Vij Nihal Wilde Tetsu Tanaka Johanna Vogelhuber Miriam Silaschi Marcel Weber Farhad Bakhtiary Georg Nickenig Sebastian Zimmer Atsushi Sugiura |
| author_sort | Mitsumasa Sudo |
| collection | DOAJ |
| description | Before the development of transcatheter interventions, patients with mitral regurgitation (MR) and high surgical risk were often conservatively treated and subject to poor prognoses. We aimed to assess the therapeutic approaches and outcomes in the contemporary era. The study participants were consecutive high-risk MR patients from April 2019 to October 2021. Among the 305 patients analyzed, 274 (89.8%) underwent mitral valve interventions, whereas 31 (10.2%) received medical therapy alone. Of the interventions, transcatheter edge-to-edge mitral repair (TEER) was the most frequent (82.0% of overall), followed by transcatheter mitral valve replacement (TMVR) (4.6%). In patients treated with medical therapy alone, non-optimal morphologies for TEER and TMVR were shown in 87.1% and 65.0%, respectively. Patients undergoing mitral valve interventions experienced less frequent heart failure (HF) rehospitalization compared to those with medical therapy alone (18.2% vs. 42.0%, <i>p</i> < 0.01). Mitral valve intervention was associated with a lower risk of HF rehospitalization (HR 0.36 [0.18–0.74]) and an improved New York Heart Association class (<i>p</i> < 0.01). Most high-risk MR patients can be treated with mitral valve interventions. However, approximately 10% remained on medical therapy alone and were considered as unsuitable for current transcatheter technologies. Mitral valve intervention was associated with a lower risk of HF rehospitalization and improved functional status. |
| first_indexed | 2024-03-11T04:52:56Z |
| format | Article |
| id | doaj.art-677e0904d68a4fe18f46806f92da6947 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T04:52:56Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-677e0904d68a4fe18f46806f92da69472023-11-17T19:51:07ZengMDPI AGJournal of Clinical Medicine2077-03832023-04-01128297810.3390/jcm12082978Contemporary Treatment and Outcomes of High Surgical Risk Mitral RegurgitationMitsumasa Sudo0Vivian Vij1Nihal Wilde2Tetsu Tanaka3Johanna Vogelhuber4Miriam Silaschi5Marcel Weber6Farhad Bakhtiary7Georg Nickenig8Sebastian Zimmer9Atsushi Sugiura10Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, GermanyHeart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, GermanyHeart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, GermanyHeart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, GermanyHeart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, GermanyHeart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, 53179 Bonn, GermanyHeart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, GermanyHeart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, 53179 Bonn, GermanyHeart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, GermanyHeart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, GermanyHeart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, 53179 Bonn, GermanyBefore the development of transcatheter interventions, patients with mitral regurgitation (MR) and high surgical risk were often conservatively treated and subject to poor prognoses. We aimed to assess the therapeutic approaches and outcomes in the contemporary era. The study participants were consecutive high-risk MR patients from April 2019 to October 2021. Among the 305 patients analyzed, 274 (89.8%) underwent mitral valve interventions, whereas 31 (10.2%) received medical therapy alone. Of the interventions, transcatheter edge-to-edge mitral repair (TEER) was the most frequent (82.0% of overall), followed by transcatheter mitral valve replacement (TMVR) (4.6%). In patients treated with medical therapy alone, non-optimal morphologies for TEER and TMVR were shown in 87.1% and 65.0%, respectively. Patients undergoing mitral valve interventions experienced less frequent heart failure (HF) rehospitalization compared to those with medical therapy alone (18.2% vs. 42.0%, <i>p</i> < 0.01). Mitral valve intervention was associated with a lower risk of HF rehospitalization (HR 0.36 [0.18–0.74]) and an improved New York Heart Association class (<i>p</i> < 0.01). Most high-risk MR patients can be treated with mitral valve interventions. However, approximately 10% remained on medical therapy alone and were considered as unsuitable for current transcatheter technologies. Mitral valve intervention was associated with a lower risk of HF rehospitalization and improved functional status.https://www.mdpi.com/2077-0383/12/8/2978mitral regurgitationmitral valve interventionoptimal medical therapy alonecontemporary management |
| spellingShingle | Mitsumasa Sudo Vivian Vij Nihal Wilde Tetsu Tanaka Johanna Vogelhuber Miriam Silaschi Marcel Weber Farhad Bakhtiary Georg Nickenig Sebastian Zimmer Atsushi Sugiura Contemporary Treatment and Outcomes of High Surgical Risk Mitral Regurgitation Journal of Clinical Medicine mitral regurgitation mitral valve intervention optimal medical therapy alone contemporary management |
| title | Contemporary Treatment and Outcomes of High Surgical Risk Mitral Regurgitation |
| title_full | Contemporary Treatment and Outcomes of High Surgical Risk Mitral Regurgitation |
| title_fullStr | Contemporary Treatment and Outcomes of High Surgical Risk Mitral Regurgitation |
| title_full_unstemmed | Contemporary Treatment and Outcomes of High Surgical Risk Mitral Regurgitation |
| title_short | Contemporary Treatment and Outcomes of High Surgical Risk Mitral Regurgitation |
| title_sort | contemporary treatment and outcomes of high surgical risk mitral regurgitation |
| topic | mitral regurgitation mitral valve intervention optimal medical therapy alone contemporary management |
| url | https://www.mdpi.com/2077-0383/12/8/2978 |
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