Joanna Chikwe1, Patrick O'Gara2, Stephen Fremes3, Thoralf M Sundt4, Robert H Habib5, James Gammie6, Mario Gaudino7, Vinay Badhwar8, Marc Gillinov9, Michael Acker10, Georgina Rowe11, George Gill11, Andrew B Goldstone10, Thomas Schwann12, Annetine Gelijns13, Alfredo Trento11, Michael Mack14, David H Adams15. 1. Department of Cardiac Surgery, Cedars-Sinai, Los Angeles, California, USA. Electronic address: Joanna.Chikwe@cshs.org. 2. Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA. 3. Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada. 4. Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. 5. The Society of Thoracic Surgeons Research Center, Chicago, Illinois, USA. 6. Division of Cardiac Surgery, University of Maryland, Baltimore, Maryland, USA. 7. Division of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA. 8. Department of Cardiovascular and Thoracic Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA. 9. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA. 10. Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 11. Department of Cardiac Surgery, Cedars-Sinai, Los Angeles, California, USA. 12. Division of Cardiac Surgery, Baystate Health, Springfield, Massachusetts, USA. 13. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 14. Baylor Health Care System, Plano, Texas USA. 15. Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Abstract
BACKGROUND: Transcatheter edge-to-edge (TEER) mitral repair may be complicated by residual or recurrent mitral regurgitation. An increasing need for surgical reintervention has been reported, but operative outcomes are ill defined. OBJECTIVES: This study evaluated national outcomes of mitral surgery after TEER. METHODS: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was used to identify 524 adults who underwent mitral surgery after TEER between July 2014 and June 2020. Emergencies (5.0%; n = 26), previous mitral surgery (5.3%; n = 28), or open implantation of transcatheter prostheses (1.5%; n = 8) were excluded. The primary outcome was 30-day or in-hospital mortality. RESULTS: In the study cohort of 463 patients, the median age was 76 years (interquartile range [IQR]: 67 to 81 years), median left ventricular ejection fraction was 57% (IQR: 48% to 62%), and 177 (38.2%) patients had degenerative disease. Major concomitant cardiac surgery was performed in 137 (29.4%) patients: in patients undergoing isolated mitral surgery, the median STS-predicted mortality was 6.5% (IQR: 3.9% to 10.5%), the observed mortality was 10.2% (n = 23 of 225), and the ratio of observed to expected mortality was 1.2 (95% confidence interval [CI]: 0.8 to 1.9). Predictors of mortality included urgent surgery (odds ratio [OR]: 2.4; 95% CI: 1.3 to 4.6), nondegenerative/unknown etiology (OR: 2.2; 95% CI: 1.1 to 4.5), creatinine of >2.0 mg/dl (OR: 3.8; 95% CI: 1.9 to 7.9) and age of >80 years (OR: 2.1; 95% CI: 1.1 to 4.4). In a volume outcomes analysis in an expanded cohort of 591 patients at 227 hospitals, operative mortality was 2.6% (n = 2 of 76) in 4 centers that performed >10 cases versus 12.4% (n = 64 of 515) in centers performing fewer (p = 0.01). The surgical repair rate after failed TEER was 4.8% (n = 22) and was 6.8% (n = 12) in degenerative disease. CONCLUSIONS: This study indicates that mitral repair is infrequently achieved after failed TEER, which may have implications for treatment choice in lower-risk and younger patients with degenerative disease. These findings should inform patient consent for TEER, clinical trial design, and clinical performance measures.
BACKGROUND: Transcatheter edge-to-edge (TEER) mitral repair may be complicated by residual or recurrent mitral regurgitation. An increasing need for surgical reintervention has been reported, but operative outcomes are ill defined. OBJECTIVES: This study evaluated national outcomes of mitral surgery after TEER. METHODS: The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was used to identify 524 adults who underwent mitral surgery after TEER between July 2014 and June 2020. Emergencies (5.0%; n = 26), previous mitral surgery (5.3%; n = 28), or open implantation of transcatheter prostheses (1.5%; n = 8) were excluded. The primary outcome was 30-day or in-hospital mortality. RESULTS: In the study cohort of 463 patients, the median age was 76 years (interquartile range [IQR]: 67 to 81 years), median left ventricular ejection fraction was 57% (IQR: 48% to 62%), and 177 (38.2%) patients had degenerative disease. Major concomitant cardiac surgery was performed in 137 (29.4%) patients: in patients undergoing isolated mitral surgery, the median STS-predicted mortality was 6.5% (IQR: 3.9% to 10.5%), the observed mortality was 10.2% (n = 23 of 225), and the ratio of observed to expected mortality was 1.2 (95% confidence interval [CI]: 0.8 to 1.9). Predictors of mortality included urgent surgery (odds ratio [OR]: 2.4; 95% CI: 1.3 to 4.6), nondegenerative/unknown etiology (OR: 2.2; 95% CI: 1.1 to 4.5), creatinine of >2.0 mg/dl (OR: 3.8; 95% CI: 1.9 to 7.9) and age of >80 years (OR: 2.1; 95% CI: 1.1 to 4.4). In a volume outcomes analysis in an expanded cohort of 591 patients at 227 hospitals, operative mortality was 2.6% (n = 2 of 76) in 4 centers that performed >10 cases versus 12.4% (n = 64 of 515) in centers performing fewer (p = 0.01). The surgical repair rate after failed TEER was 4.8% (n = 22) and was 6.8% (n = 12) in degenerative disease. CONCLUSIONS: This study indicates that mitral repair is infrequently achieved after failed TEER, which may have implications for treatment choice in lower-risk and younger patients with degenerative disease. These findings should inform patient consent for TEER, clinical trial design, and clinical performance measures.
Authors: Nicole Lewandowski; Ehssan Berenjkoub; Eduard Gorr; Marc Horlitz; Peter Boekstegers; Mirko Doss; Sami Sirat; Dennis Rottländer Journal: Front Cardiovasc Med Date: 2022-01-06
Authors: Piotr Mazur; Arman Arghami; Clark Zheng; Mohamad Alkhouli; Hartzell V Schaff; Joseph Dearani; Richard C Daly; Kevin Greason; Juan A Crestanello Journal: JTCVS Tech Date: 2022-05-14