Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison - Inserm - Institut national de la santé et de la recherche médicale Accéder directement au contenu
Article Dans Une Revue Circulation: Cardiovascular Interventions Année : 2023

Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison

1 UKE - Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg]
2 DZHK - German Center for Cardiovascular Research
3 CRF - Cardiovascular Research Foundation [New York, NY, USA]
4 University Heart Center [Hamburg]
5 St. Francis Hospital - Roslyn [New York, NY, USA]
6 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
7 Institut Pasteur de Lille
8 The Ohio State University Press
9 Montreal Heart Institute - Institut de Cardiologie de Montréal
10 QUB - Queen's University [Belfast]
11 Royal Brompton Hospital
12 University of Virginia
13 UniBs - Università degli Studi di Brescia = University of Brescia
14 University of Cologne
15 St. Vincent's Hospital, Sydney
16 SPH-UBC - St. Paul’s Hospital - University of British Columbia [Vancouver, BC, Canada]
17 University of Pisa - Università di Pisa
18 GHC - German Heart Center = Deutsches Herzzentrum München [Munich, Germany]
19 HCB - Heart Center Bonn [Bonn, Germany]
20 HNC - Hôpital national = Rigshospitalet [Copenhagen, Denmark]
21 University Hospital of Cologne [Cologne]
22 IRCCS Milan - Istituto Clinico Humanitas [Milan]
23 IRCCS Policlinico San Donato [Milan, Italy]
24 Medizinische Universität Wien = Medical University of Vienna
25 Oslo University Hospital [Oslo]
26 Frankfurt University Hospital
27 MSH - Mount Sinai Hospital [New York City, NY, USA]
28 Guy's and St Thomas' Hospital [London]
29 HCL - Heart Center Hirslanden = HerzZentrum Hirslanden [Zürich, Switzerland]
30 Inselspital - Bern University Hospital [Berne]
31 St. Michael's Hospital
32 Clinique Pasteur [Toulouse]
33 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
34 University Medical Center [Mainz]
35 HDC - Heart and Diabetes Center NRW [Bad Oeynhausen, Germany]
36 Houston Methodist Hospital [Houston, TX, USA]
37 IRCCS Ospedale San Raffaele [Milan, Italy]
38 Baylor Scott & White The Heart Hospital [Plano, TX, USA]
39 LMU - Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München
40 MedStar-HRI - MedStar Health Research Institute [Washington, DC, USA]
41 Montefiore Medical Center [Bronx, New York]
42 Vanderbilt Heart/Vascular Institute [Nashville, TN, USA]
43 CHU Bordeaux
44 MSSM - Icahn School of Medicine at Mount Sinai [New York]
D. S. Lim
  • Fonction : Auteur
T. Schmidt
  • Fonction : Auteur
N. Fam
  • Fonction : Auteur
T. Modine
  • Fonction : Auteur

Résumé

BACKGROUND: Transcatheter mitral valve replacement (TMVR) is an emerging therapeutic alternative for patients with secondary mitral regurgitation (MR). Outcomes of TMVR versus guideline-directed medical therapy (GDMT) have not been investigated for this population. This study aimed to compare clinical outcomes of patients with secondary MR undergoing TMVR versus GDMT alone. METHODS: The CHOICE-MI registry (Choice of Optimal Transcatheter Treatment for Mitral Insufficiency) included patients with MR undergoing TMVR using dedicated devices. Patients with MR pathogeneses other than secondary MR were excluded. Patients treated with GDMT alone were derived from the control arm of the COAPT trial (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation). We compared outcomes between the TMVR and GDMT groups, using propensity score matching to adjust for baseline differences. RESULTS: After propensity score matching, 97 patient pairs undergoing TMVR (72.9±8.7 years; 60.8% men; transapical access, 91.8%) versus GDMT (73.1±11.0 years; 59.8% men) were compared. At 1 and 2 years, residual MR was ≤1+ in all patients of the TMVR group compared with 6.9% and 7.7%, respectively, in those receiving GDMT alone (both P\textless0.001). The 2-year rate of heart failure hospitalization was significantly lower in the TMVR group (32.8% versus 54.4%; hazard ratio, 0.59 [95% CI, 0.35-0.99]; P=0.04). Among survivors, a higher proportion of patients were in the New York Heart Association functional class I or II in the TMVR group at 1 year (78.2% versus 59.7%; P=0.03) and at 2 years (77.8% versus 53.2%; P=0.09). Two-year mortality was similar in the 2 groups (TMVR versus GDMT, 36.8% versus 40.8%; hazard ratio, 1.01 [95% CI, 0.62-1.64]; P=0.98). CONCLUSIONS: In this observational comparison, over 2-year follow-up, TMVR using mostly transapical devices in patients with secondary MR was associated with significant reduction of MR, symptomatic improvement, less frequent hospitalizations for heart failure, and similar mortality compared with GDMT. REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT04688190 (CHOICE-MI) and NCT01626079 (COAPT).
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inserm-04431641 , version 1 (01-02-2024)

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S. Ludwig, L. Conradi, D. J. Cohen, A. Coisne, A. Scotti, et al.. Transcatheter Mitral Valve Replacement Versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison. Circulation: Cardiovascular Interventions, 2023, 16 (6), pp.e013045. ⟨10.1161/circinterventions.123.013045⟩. ⟨inserm-04431641⟩
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