P118. Benchmark for Intermediate Surgical Risk Primary Mitral Regurgitation Patients Undergoing Surgical or Transcatheter Valve Repair
Presented During: Adult Cardiac Poster Session II
Michigan Medicine - University of Michigan
Ann Arbor, MI
United States - Contact Me
T32 Research Fellow and General Surgery pursuing Cardiothoracic Surgery.
Monday, May 4, 2026: 9:00 AM - 4:00 PM
McCormick Place Lakeside Center
Room: Exhibit Hall, Poster Area
Description
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.
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
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.
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
Presentation Duration
There is no formal presentation for posters. Your poster will be on display on your assigned day from 9:00AM - 4:00PM
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ADULT CARDIAC
Mitral and Tricuspid Valve