Edge-to Edge Repair is Safe and Effective as a Supplement to Mitral Valve Repair, With No Effect on Transmitral Gradients

MP019 

Abstract Submission 

Connor Barrett (1), Cameron Ekanayake (1), Jocelyn Sun (1), Fanny Lodge (1), Matthew Clynes (1), Anna Lampe (1), Riley Sevensky (1), Hannah N. W. Weinstein (1), Alexis Schiazza (1), David Morales (1), Hiroo Takayama (1), Koji Takeda (1), Isaac George (1), Craig Smith, MD (1), Paul Kurlansky, MD (1), Michael Argenziano (1)

(1) Columbia University Medical Center, New York, NY

Connor Barrett    -  Contact Me
Columbia University Medical Center

Cameron Ekanayake    -  Contact Me
Columbia University Medical Center

Jocelyn Sun    -  Contact Me
Columbia University Medical Center

Fanny Lodge    -  Contact Me
Columbia University Medical Center

Matthew Clynes    -  Contact Me
Columbia University Medical Center

Anna Lampe    -  Contact Me
Columbia University Medical Center

Riley Sevensky    -  Contact Me
Columbia University Medical Center

Hannah N. W. Weinstein    -  Contact Me
Columbia University Medical Center

Alexis Schiazza    -  Contact Me
Columbia University Medical Center

David Morales    -  Contact Me
Columbia University Medical Center

*Hiroo Takayama    -  Contact Me
Columbia University Medical Center

*Koji Takeda    -  Contact Me
Columbia University Medical Center

*Isaac George    -  Contact Me
Columbia University Medical Center

*Craig Smith    -  Contact Me
Columbia University Medical Center

*Paul Kurlansky, MD    -  Contact Me
Columbia University Medical Center

*Michael Argenziano    -  Contact Me
Columbia University Medical Center

Connor Barrett    -  Contact Me
Columbia University Medical Center

Objective: The Edge-to-Edge repair (EE), achieved by suturing of anterior to posterior leaflet segments, is often used to improve mitral leaflet apposition during mitral valve repair (MVr) for degenerative mitral regurgitation (DMR). Because EE creates a double-orifice valve, it introduces a theoretical risk of mitral stenosis (MS). In our unit, EE is primarily used as an adjunct to other more complex repair techniques, and only if there is sufficient available mitral orifice area. We examined the impact of EE repair on postoperative mitral valve gradient (MVG).

Methods: Data was retrospectively collected from 567 consecutive adult patients undergoing MVr for mitral insufficiency at our institution between 2015 and 2020. Of these, 249 operations were MVr with annuloplasty in patients with DMR, no history of MV surgery, VAD implantation, or heart transplant. Outcomes stratified by EE usage were evaluated in propensity score matching. The primary outcome was MVG. Secondary outcomes included postoperative
complications, re-hospitalization, and re-operation.

Results: Our cohort consisted of 46 (18%) patients who received EE and 203 (82%) who did not. Propensity score matching compared 40 patients who received EE repair and 40 patients who did not. There were no differences in MVG (median 3.2 vs 4.0, p = 0.06); no differences in post-operative complications such as atrial fibrillation (p = 0.822), AKI or CKD (p = 1.00), stroke (p = 1.00), or mortality (p = 1.00); and no differences in re-operation (p = 0.239) or re-hospitalization (p = 0.35). Among the unadjusted (overall) patient cohort who received EE, there was one death and one case of high postoperative MVG (> 10 mmHg).

Conclusions: Our data suggests that EE as a supplemental MVr technique increases the technical options for successful mitral repair. EE resulted in rates of repair success comparable to non-EE techniques, without significant increases in postoperative mitral gradients, demonstrating the safety and efficacy of this technique. One case of a high mitral gradient on post-discharge testing illustrates the importance of assessing the post-repair mitral gradient by TEE in the operating room.

Mitral Repair Techniques & Strategies