Benchmark for Intermediate Surgical Risk Primary Mitral Regurgitation Patients Undergoing Surgical or Transcatheter Valve Repair
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0118
Submission Type:
Abstract Submission
Authors:
Sanjhai Ramdeen (1), Shawn Reginauld (1), Dani Ahmetovic (1), Gurnoordeep Pawar (1), Ricky Patil (1), Carol Ling (1), Jeremy Wolverton (1), China Green (1), Matthew Romano (1), Steven Bolling (1), Robert Hawkins (2), Gorav Ailawadi (1)
Institutions:
(1) University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, (2) University of Michigan, Department of Cardiac Surgery, Ann Arbor, MI
Submitting Author:
Sanjhai Ramdeen
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
Co-Author(s):
Shawn Reginauld
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
Dani Ahmetovic
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
Gurnoordeep Pawar
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
Ricky Patil
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
Carol Ling
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
Jeremy Wolverton
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
China Green
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
*Matthew Romano
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
*Steven Bolling
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
Robert Hawkins
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University of Michigan, Department of Cardiac Surgery
University of Michigan, Department of Cardiac Surgery
*Gorav Ailawadi
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University of Michigan Frankel Cardiovascular Center
University of Michigan Frankel Cardiovascular Center
Presenting Author:
Sanjhai Ramdeen
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Michigan Medicine - University of Michigan
Michigan Medicine - University of Michigan
Abstract:
Objective: Two ongoing trials comparing transcatheter edge-to-edge repair (TEER) to surgical mitral repair (MVr) for primary mitral regurgitation (MR) include intermediate surgical risk patients, but results are still years away. Nevertheless, TEER use has recently increased in intermediate risk patients without evidence. This study aims to assess outcomes of MVr and TEER in patients with severe primary mitral regurgitation who are at least intermediate risk.
Methods: All patients with severe primary MR undergoing MVr or TEER with intermediate or higher surgical risk (STS PROM ≥ 2% or age ≥ 75) between 2014 and 2025 at a single quaternary institution were included. Patients with severe mitral annular calcification, prior mitral surgery, a ventricular assist device, dialysis dependence or severe tricuspid regurgitation (TR) were excluded. Concomitant operations included CABG, left atrial appendage exclusion, Maze and tricuspid repair (for less than severe TR). Primary outcomes were observed versus expected (O:E) mortality.
Results: A total of 343 patients (mean age=78 ±7 years) underwent MVr (n=295) or TEER (n=48). MVr patients were younger, had fewer previous MI and stroke, but had similar frequency of heart failure. MVr patients had lower STS PROM (3.2% ± 0.3 vs. 6.8% ± 1.0, p< 0.001). Operative mortality was 3.1% (9/295, O:E=0.97) in the MVr group and 2.1% in the TEER (1/48, O:E=0.31, p<0.001) group. There was no difference in discharge location between groups, p=0.36.
Post-repair transesophageal echocardiography (TEE) demonstrated a greater proportion of mild or less residual MR following MVr compared to TEER (99.7% [294/295] vs. 37.4% [19/48], p<0.001). The post-repair mean mitral gradient was 2.8±1.3 and was lower in the MVr group (2.7±1.3 vs 3.3±1.4, p=0.017). On most recent echocardiography, 68.5% (202/295) of MVr patients had mild or less regurgitation versus 27.1% (13/48) for TEER patients (p<0.001). At a mean 1.9 years of follow-up, MVr patients were less likely to require repeat mitral intervention (1.4% [4/295] vs. 10.4% [5/48], p<0.001).
Conclusions: Surgical mortality for intermediate risk patients is consistent with STS PROM, but lower than predicted for TEER. Early and late post procedural outcomes for surgical repair are favorable with minimal residual MR and rare reintervention at nearly two years. Ongoing clinical trial results will weigh the balance between surgery and TEER of higher procedural risk with better durability.
Methods: All patients with severe primary MR undergoing MVr or TEER with intermediate or higher surgical risk (STS PROM ≥ 2% or age ≥ 75) between 2014 and 2025 at a single quaternary institution were included. Patients with severe mitral annular calcification, prior mitral surgery, a ventricular assist device, dialysis dependence or severe tricuspid regurgitation (TR) were excluded. Concomitant operations included CABG, left atrial appendage exclusion, Maze and tricuspid repair (for less than severe TR). Primary outcomes were observed versus expected (O:E) mortality.
Results: A total of 343 patients (mean age=78 ±7 years) underwent MVr (n=295) or TEER (n=48). MVr patients were younger, had fewer previous MI and stroke, but had similar frequency of heart failure. MVr patients had lower STS PROM (3.2% ± 0.3 vs. 6.8% ± 1.0, p< 0.001). Operative mortality was 3.1% (9/295, O:E=0.97) in the MVr group and 2.1% in the TEER (1/48, O:E=0.31, p<0.001) group. There was no difference in discharge location between groups, p=0.36.
Post-repair transesophageal echocardiography (TEE) demonstrated a greater proportion of mild or less residual MR following MVr compared to TEER (99.7% [294/295] vs. 37.4% [19/48], p<0.001). The post-repair mean mitral gradient was 2.8±1.3 and was lower in the MVr group (2.7±1.3 vs 3.3±1.4, p=0.017). On most recent echocardiography, 68.5% (202/295) of MVr patients had mild or less regurgitation versus 27.1% (13/48) for TEER patients (p<0.001). At a mean 1.9 years of follow-up, MVr patients were less likely to require repeat mitral intervention (1.4% [4/295] vs. 10.4% [5/48], p<0.001).
Conclusions: Surgical mortality for intermediate risk patients is consistent with STS PROM, but lower than predicted for TEER. Early and late post procedural outcomes for surgical repair are favorable with minimal residual MR and rare reintervention at nearly two years. Ongoing clinical trial results will weigh the balance between surgery and TEER of higher procedural risk with better durability.
ADULT CARDIAC:
Mitral and Tricuspid Valve
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