Transcatheter Edge-to-Edge Repair Versus Annuloplasty in Functional Mitral Valve Regurgitation: A Comparison of Cardiovascular Outcomes

Abstract

Background: The EVEREST trials established the MitraClip as a viable alternative to surgery in treating functional mitral valve regurgitation (FMVR). The MitraClip G4 offers a less invasive way of managing severe FMVR. We sought to compare in-patient mortality and cardiovascular complications in patients with heart failure with reduced ejection fraction (HFrEF) who developed severe FMVR requiring treatment with MitraClip G4 versus annuloplasty. Comparisons of outcomes to previous iterations of the MitraClip were included in the analysis.

Methods: Using the National Inpatient Sample, we included adult patients with FMVR and HFrEF between 2016 and 2020 who underwent percutaneous repair or annuloplasty. MitraClip G4 use was assumed for MitraClip performed in the third quarter of 2019 and afterward. To avoid overlap between the G4 and previous iterations, MitraClip data from 2019 were excluded. Mortality, stroke, and other complications were assessed. Survey-weighted logistic regression was used to adjust for selection bias in the treatment received based on age and comorbidities. The weighted analysis included 19,500 patients receiving either MitraClip G4 or annuloplasty.

Results: The MitraClip group was associated with a decreased risk of in-hospital mortality (odds ratio (OR): 0.38, confidence interval (CI): 0.18 - 0.77), ischemic stroke (OR: 0.29, CI: 0.13 - 0.61), and myocardial infarction (OR: 0.15, CI: 0.08 - 0.28). The MitraClip G4 cohort did not outperform earlier clip versions in reducing complications.

Conclusions: The MitraClip G4 was associated with lower in-hospital mortality and cardiovascular complications than annuloplasty but had outcomes similar to earlier clip versions. Additional studies comparing percutaneous therapies and surgical interventions are necessary to determine optimal treatment strategies for patients with FMVR.