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Original research
Heart team approach in treatment of mitral regurgitation: patient selection and outcome
  1. Mischa Külling1,
  2. Roberto Corti2,
  3. Georg Noll2,
  4. Silke Küest2,
  5. David Hürlimann2,
  6. Christophe Wyss2,
  7. Ivano Reho2,
  8. Felix C Tanner3,
  9. Jeremy Külling4,
  10. Nicolai Meinshausen4,
  11. Oliver Gaemperli2,
  12. Peter Wenaweser2,
  13. Sacha P Salzberg2,
  14. Thierry Aymard2,
  15. Jürg Grünenfelder2 and
  16. Patric Biaggi2
  1. 1Faculty of Medicine, University of Zurich, Zurich, Switzerland
  2. 2Heart Clinic Zurich, Hirslanden Hospital Hirslanden, Zurich, Switzerland
  3. 3Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
  4. 4Swiss Federal Institute of Technology, Zurich, Switzerland
  1. Correspondence to Dr Patric Biaggi; patric.biaggi{at}hirslanden.ch

Abstract

Objective A multidisciplinary heart valve team is recommended for the evaluation of treatment in patients with valvular heart disease, but evidence supporting this concept is lacking. In patients with severe mitral regurgitation, we thought to analyse the patient selection process by the heart team for different treatment options and the outcome after treatment.

Methods In this single-centre cohort study, all patients treated for mitral regurgitation between July 2013 and September 2018 were included. Primary end points during follow-up were all-cause mortality and a combined end point, consisting of all-cause mortality, cardiovascular rehospitalisation and mitral valve reintervention.

Results 179 patients (44.8%) were treated using Mitraclip, 185 (46.2%) by surgical repair and 36 (9.0%) by surgical replacement. The mortality risk according to EuroScore II differed significantly between treatment groups (6.6%±5.6%, 1.7%±1.5% and 3.6%±2.7% for Mitraclip, surgical repair and replacement, respectively, p<0.001). In-hospital mortality for the 3 groups were 3.4%, 1.6% and 8.3%, respectively (p=0.091). Overall, surgical repair patients had higher 4-year survival (HR 0.40 (95% CI 0.26 to 0.63), p<0.001) and fewer combined end points (HR 0.51 (95% CI 0.32 to 0.80), p<0.001) compared with surgical replacement and Mitraclip patients. However, patients undergoing Mitraclip for isolated, primary mitral regurgitation achieved very good long-term survival.

Conclusion The multidisciplinary heart team assigned only low-risk patients with favourable anatomy to surgical repair, while high-risk patients underwent Mitraclip or surgical replacement. This strategy was associated with lower than expected in-hospital mortality for Mitraclip patients and high 4-year survival rates for patients undergoing surgical or percutaneous repair of isolated primary mitral regurgitation.

  • surgery-valve
  • percutaneous valve therapy
  • mitral regurgitation
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors All authors have contributed significantly to the content of the article. Each one has read and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Written informed consent was given by all patients, and the study protocol was approved by the Cantonal Ethics Commission Zurich (Protocol Number 2017–01895).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article.

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