In the Journals

Transcatheter mitral valve repair improves health status

Patients who underwent edge-to-edge transcatheter mitral valve repair for mitral regurgitation had improved symptoms, functional status and quality of life at 1 year, according to new findings.

The researchers analyzed 4,226 patients (median age, 81 years; 47% women) from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry who underwent transcatheter mitral valve repair for severe mitral regurgitation between 2013 and 2017.

The primary outcome was change in Kansas City Cardiomyopathy Questionnaire - Overall Summary score (KCCQ-OS) at 30 days and 1 year.

Mean KCCQ-OS score increased from 41.9 at baseline to 66.7 at 30 days (mean change, 24.8 points; 95% CI, 24-25.6) and remained consistent between 30 days and 1 year, Suzanne V. Arnold, MD, MHA, from Saint Luke’s Mid America Heart Institute and the University of Missouri and a Cardiology Today Next Gen Innovator, and colleagues wrote.

The researchers identified the following factors as independently associated with lower KCCQ-OS scores:

  • atrial fibrillation, –2.2 points; 95% CI, –3.7 to –0.6;
  • permanent pacemaker implantation, –2.1 points; 95% CI, –3.7 to –0.4;
  • severe lung disease, –3.9 points; 95% CI, –6.2 to –1.5;
  • home oxygen, –2.7 points; 95% CI, –4.9 to –0.4; and
  • lower baseline KCCQ-OS score, 3.9 points for each 10-point increase; 95% CI, 3.6-4.2.

When the researchers calculated estimates with inverse probability weighting, they found that at 1 year, 54.2% (95% CI, 52.2-56.1) of patients were alive and well; 23% died; 21.9% had persistently poor health status, defined as KCCQ-OS score less than 60 points; 5.5% declined in health status from baseline and 4.6% had persistently poor health status and declined in health status from baseline.

“Using these data to help inform the decision process prior to [transcatheter mitral valve repair] may help improve patient selection as well as patient expectations for recovery, particularly if a number of risk factors for worse health status are present in an individual patient,” Arnold and colleagues wrote. “For a procedure that is currently reserved for patients who are poor candidates for valve surgery, is mainly performed to improve quality of life, and has low periprocedural risk, however, the health status outcomes of surviving patients are encouraging and support the continued use of edge-to-edge [transcatheter mitral valve repair] in selected patients who are poor candidates for cardiac surgery.” – by Erik Swain

Disclosures: Arnold reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures

Patients who underwent edge-to-edge transcatheter mitral valve repair for mitral regurgitation had improved symptoms, functional status and quality of life at 1 year, according to new findings.

The researchers analyzed 4,226 patients (median age, 81 years; 47% women) from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry who underwent transcatheter mitral valve repair for severe mitral regurgitation between 2013 and 2017.

The primary outcome was change in Kansas City Cardiomyopathy Questionnaire - Overall Summary score (KCCQ-OS) at 30 days and 1 year.

Mean KCCQ-OS score increased from 41.9 at baseline to 66.7 at 30 days (mean change, 24.8 points; 95% CI, 24-25.6) and remained consistent between 30 days and 1 year, Suzanne V. Arnold, MD, MHA, from Saint Luke’s Mid America Heart Institute and the University of Missouri and a Cardiology Today Next Gen Innovator, and colleagues wrote.

The researchers identified the following factors as independently associated with lower KCCQ-OS scores:

  • atrial fibrillation, –2.2 points; 95% CI, –3.7 to –0.6;
  • permanent pacemaker implantation, –2.1 points; 95% CI, –3.7 to –0.4;
  • severe lung disease, –3.9 points; 95% CI, –6.2 to –1.5;
  • home oxygen, –2.7 points; 95% CI, –4.9 to –0.4; and
  • lower baseline KCCQ-OS score, 3.9 points for each 10-point increase; 95% CI, 3.6-4.2.

When the researchers calculated estimates with inverse probability weighting, they found that at 1 year, 54.2% (95% CI, 52.2-56.1) of patients were alive and well; 23% died; 21.9% had persistently poor health status, defined as KCCQ-OS score less than 60 points; 5.5% declined in health status from baseline and 4.6% had persistently poor health status and declined in health status from baseline.

“Using these data to help inform the decision process prior to [transcatheter mitral valve repair] may help improve patient selection as well as patient expectations for recovery, particularly if a number of risk factors for worse health status are present in an individual patient,” Arnold and colleagues wrote. “For a procedure that is currently reserved for patients who are poor candidates for valve surgery, is mainly performed to improve quality of life, and has low periprocedural risk, however, the health status outcomes of surviving patients are encouraging and support the continued use of edge-to-edge [transcatheter mitral valve repair] in selected patients who are poor candidates for cardiac surgery.” – by Erik Swain

Disclosures: Arnold reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures

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