Minimally Invasive Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair

Alejandro Pizano; Ramon Riojas; Gorav Ailawadi; Robert L. Smith; Timothy George; Marc W. Gerdisch; Marco Di Eusanio; Mario Castillo-Sang; Basel Ramlawi; Evelio Rodriguez; Michael A. Morse; Neelan S. Doolabh; Michael E. Jessen; Lawrence Wei; Michael W.A. Chu; Paolo Berretta; Erik Cura Stura; Stefano Salizzoni; Mauro Rinaldi; Tsuyoshi Kaneko; Gilbert H.L. Tang; Joanna Chikwe; Amy Roach; Alfredo Trento; Vinay Badhwar; Tom C. Nguyen

doi:10.1177/15569845211070568

Minimally Invasive Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair

Alejandro Pizano, Ramon Riojas, Gorav Ailawadi, Robert L. Smith, Timothy George, Marc W. Gerdisch, Marco Di Eusanio, Mario Castillo-Sang, Basel Ramlawi, Evelio Rodriguez, Michael A. Morse, Neelan S. Doolabh, Michael E. Jessen, Lawrence Wei, Michael W.A. Chu, Paolo Berretta, Erik Cura Stura, Stefano Salizzoni, Mauro Rinaldi, Tsuyoshi KanekoGilbert H.L. Tang, Joanna Chikwe, Amy Roach, Alfredo Trento, Vinay Badhwar, Tom C. Nguyen

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Objective: Up to 28% of patients may need mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). This study evaluates the outcomes of minimally invasive MV surgery after TEER. Methods: International multicenter registry of minimally invasive MV surgery after TEER between 2013 and 2020. Subgroups were stratified by the number of devices implanted (≤1 vs >1), as well as time interval from TEER to surgery (≤1 year vs >1 year). Results: A total of 56 patients across 13 centers were included with a mean age of 73 ± 11 years, and 50% were female. The median Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) score for MV replacement was 8% (Q1-Q3 = 5% to 11%) and the ratio of observed to expected mortality was 0.9. The etiology of mitral regurgitation (MR) prior to TEER was primary MR in 75% of patients and secondary MR in 25%. There were 30 patients (54%) who had >1 device implanted. The median time between TEER and surgery was 252 days (33 to 636 days). Hemodynamics, including MR severity, MV area, and mean gradient, significantly improved after minimally invasive surgery and sustained to 1-year follow-up. In-hospital and 30-day mortality was 7.1%, and 1-year actuarial survival was 85.6% ± 6%. Conclusions: Minimally invasive MV surgery after TEER may be achieved as predicted by the STS PROM. Most patients underwent MV replacement instead of repair. As TEER is applied more widely, patients should be informed about the potential need for surgical intervention over time after TEER. These discussions will allow better informed consent and post-procedure planning.

Original language	English (US)
Pages (from-to)	42-49
Number of pages	8
Journal	Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume	17
Issue number	1
DOIs	https://doi.org/10.1177/15569845211070568
State	Published - Jan 2022

Keywords

minimally invasive surgery
mitral regurgitation
mitral valve
mitral valve repair
mitral valve replacement

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine

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10.1177/15569845211070568

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Pizano, A., Riojas, R., Ailawadi, G., Smith, R. L., George, T., Gerdisch, M. W., Di Eusanio, M., Castillo-Sang, M., Ramlawi, B., Rodriguez, E., Morse, M. A., Doolabh, N. S., Jessen, M. E., Wei, L., Chu, M. W. A., Berretta, P., Cura Stura, E., Salizzoni, S., Rinaldi, M., ... Nguyen, T. C. (2022). Minimally Invasive Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 17(1), 42-49. https://doi.org/10.1177/15569845211070568

Pizano, A, Riojas, R, Ailawadi, G, Smith, RL, George, T, Gerdisch, MW, Di Eusanio, M, Castillo-Sang, M, Ramlawi, B, Rodriguez, E, Morse, MA, Doolabh, NS , Jessen, ME, Wei, L, Chu, MWA, Berretta, P, Cura Stura, E, Salizzoni, S, Rinaldi, M, Kaneko, T, Tang, GHL, Chikwe, J, Roach, A, Trento, A, Badhwar, V & Nguyen, TC 2022, 'Minimally Invasive Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair', Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, vol. 17, no. 1, pp. 42-49. https://doi.org/10.1177/15569845211070568

@article{5d3bb04278d64ba9a851a80b6d5bd728,

title = "Minimally Invasive Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair",

abstract = "Objective: Up to 28% of patients may need mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). This study evaluates the outcomes of minimally invasive MV surgery after TEER. Methods: International multicenter registry of minimally invasive MV surgery after TEER between 2013 and 2020. Subgroups were stratified by the number of devices implanted (≤1 vs >1), as well as time interval from TEER to surgery (≤1 year vs >1 year). Results: A total of 56 patients across 13 centers were included with a mean age of 73 ± 11 years, and 50% were female. The median Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) score for MV replacement was 8% (Q1-Q3 = 5% to 11%) and the ratio of observed to expected mortality was 0.9. The etiology of mitral regurgitation (MR) prior to TEER was primary MR in 75% of patients and secondary MR in 25%. There were 30 patients (54%) who had >1 device implanted. The median time between TEER and surgery was 252 days (33 to 636 days). Hemodynamics, including MR severity, MV area, and mean gradient, significantly improved after minimally invasive surgery and sustained to 1-year follow-up. In-hospital and 30-day mortality was 7.1%, and 1-year actuarial survival was 85.6% ± 6%. Conclusions: Minimally invasive MV surgery after TEER may be achieved as predicted by the STS PROM. Most patients underwent MV replacement instead of repair. As TEER is applied more widely, patients should be informed about the potential need for surgical intervention over time after TEER. These discussions will allow better informed consent and post-procedure planning.",

keywords = "minimally invasive surgery, mitral regurgitation, mitral valve, mitral valve repair, mitral valve replacement",

author = "Alejandro Pizano and Ramon Riojas and Gorav Ailawadi and Smith, {Robert L.} and Timothy George and Gerdisch, {Marc W.} and {Di Eusanio}, Marco and Mario Castillo-Sang and Basel Ramlawi and Evelio Rodriguez and Morse, {Michael A.} and Doolabh, {Neelan S.} and Jessen, {Michael E.} and Lawrence Wei and Chu, {Michael W.A.} and Paolo Berretta and {Cura Stura}, Erik and Stefano Salizzoni and Mauro Rinaldi and Tsuyoshi Kaneko and Tang, {Gilbert H.L.} and Joanna Chikwe and Amy Roach and Alfredo Trento and Vinay Badhwar and Nguyen, {Tom C.}",

note = "Funding Information: Chris Akers for original illustrations. The author(s) received no financial support for the research, authorship, and/or publication of this article. Publisher Copyright: {\textcopyright} The Author(s) 2022.",

year = "2022",

month = jan,

doi = "10.1177/15569845211070568",

language = "English (US)",

volume = "17",

pages = "42--49",

journal = "Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery",

issn = "1556-9845",

publisher = "Lippincott Williams and Wilkins",

number = "1",

}

TY - JOUR

T1 - Minimally Invasive Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair

AU - Pizano, Alejandro

AU - Riojas, Ramon

AU - Ailawadi, Gorav

AU - Smith, Robert L.

AU - George, Timothy

AU - Gerdisch, Marc W.

AU - Di Eusanio, Marco

AU - Castillo-Sang, Mario

AU - Ramlawi, Basel

AU - Rodriguez, Evelio

AU - Morse, Michael A.

AU - Doolabh, Neelan S.

AU - Jessen, Michael E.

AU - Wei, Lawrence

AU - Chu, Michael W.A.

AU - Berretta, Paolo

AU - Cura Stura, Erik

AU - Salizzoni, Stefano

AU - Rinaldi, Mauro

AU - Kaneko, Tsuyoshi

AU - Tang, Gilbert H.L.

AU - Chikwe, Joanna

AU - Roach, Amy

AU - Trento, Alfredo

AU - Badhwar, Vinay

AU - Nguyen, Tom C.

N1 - Funding Information: Chris Akers for original illustrations. The author(s) received no financial support for the research, authorship, and/or publication of this article. Publisher Copyright: © The Author(s) 2022.

PY - 2022/1

Y1 - 2022/1

N2 - Objective: Up to 28% of patients may need mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). This study evaluates the outcomes of minimally invasive MV surgery after TEER. Methods: International multicenter registry of minimally invasive MV surgery after TEER between 2013 and 2020. Subgroups were stratified by the number of devices implanted (≤1 vs >1), as well as time interval from TEER to surgery (≤1 year vs >1 year). Results: A total of 56 patients across 13 centers were included with a mean age of 73 ± 11 years, and 50% were female. The median Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) score for MV replacement was 8% (Q1-Q3 = 5% to 11%) and the ratio of observed to expected mortality was 0.9. The etiology of mitral regurgitation (MR) prior to TEER was primary MR in 75% of patients and secondary MR in 25%. There were 30 patients (54%) who had >1 device implanted. The median time between TEER and surgery was 252 days (33 to 636 days). Hemodynamics, including MR severity, MV area, and mean gradient, significantly improved after minimally invasive surgery and sustained to 1-year follow-up. In-hospital and 30-day mortality was 7.1%, and 1-year actuarial survival was 85.6% ± 6%. Conclusions: Minimally invasive MV surgery after TEER may be achieved as predicted by the STS PROM. Most patients underwent MV replacement instead of repair. As TEER is applied more widely, patients should be informed about the potential need for surgical intervention over time after TEER. These discussions will allow better informed consent and post-procedure planning.

AB - Objective: Up to 28% of patients may need mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). This study evaluates the outcomes of minimally invasive MV surgery after TEER. Methods: International multicenter registry of minimally invasive MV surgery after TEER between 2013 and 2020. Subgroups were stratified by the number of devices implanted (≤1 vs >1), as well as time interval from TEER to surgery (≤1 year vs >1 year). Results: A total of 56 patients across 13 centers were included with a mean age of 73 ± 11 years, and 50% were female. The median Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) score for MV replacement was 8% (Q1-Q3 = 5% to 11%) and the ratio of observed to expected mortality was 0.9. The etiology of mitral regurgitation (MR) prior to TEER was primary MR in 75% of patients and secondary MR in 25%. There were 30 patients (54%) who had >1 device implanted. The median time between TEER and surgery was 252 days (33 to 636 days). Hemodynamics, including MR severity, MV area, and mean gradient, significantly improved after minimally invasive surgery and sustained to 1-year follow-up. In-hospital and 30-day mortality was 7.1%, and 1-year actuarial survival was 85.6% ± 6%. Conclusions: Minimally invasive MV surgery after TEER may be achieved as predicted by the STS PROM. Most patients underwent MV replacement instead of repair. As TEER is applied more widely, patients should be informed about the potential need for surgical intervention over time after TEER. These discussions will allow better informed consent and post-procedure planning.

KW - minimally invasive surgery

KW - mitral regurgitation

KW - mitral valve

KW - mitral valve repair

KW - mitral valve replacement

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U2 - 10.1177/15569845211070568

DO - 10.1177/15569845211070568

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SN - 1556-9845

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JO - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

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ER -

Minimally Invasive Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair

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