Transcatheter versus Open Mitral Valve Repair

Objective: The purpose of this article is to compare the outcomes of transcatheter mitral valve repair (TMVr) using the MitraClip© and open surgical mitral valve repair.1 Method: The method performed was a literature review with PubMed, Google Scholar, and Medline conducted using the search terms transcatheter mitral valve repair. Results: The thirty-day operative mortality for TMVr and open repair were 6% and 16% respectively (95% CI, p-value of -0.01). 2 For postoperative CVA, TMVr and open repair revealed 3% and 4%, respectively (95% CI).2 The survival rates at one year for TMVr and open repair were 69% and 67%, and at 5 years were 23% and 29%, respectively (95% CI).2 At five years follow-up, the combination of freedom from death, surgery, or 3+ or 4+ MR in the as-treated population was 44.2% versus 64.3% in the TMVr and open repair groups, respectively (p = 0.01).3 There was no significant difference in mortality (open repair 20.8% vs. TMVr 26.8%; p = 0.36). The TMVr group did experience more surgery or reoperation (27.9% vs. 8.9%; p = 0.003) and more 3+ or 4+ MR (12.3% vs. 1.8%; p = 0.02). Freedom from death and surgery for the TMVr and the open repair group was found to be 60.6% and 73.3% respectively (p = 0.03). The majority of surgeries occurred in the first 6 months (33 out of 43). This difference was not found at 6 months to 5 years (77.7% TMVr vs. 76.2% open repair; p = 0.77). At 5 years, 3+ or 4+ MR was 2.5% for open repair versus 18.8% for TMVr; p = 0.01). The New York Heart Association (NYHA) functional class III/IV symptoms were similar at 1 year and 5 years (TMVr 7.5% vs. open repair 1.0%; p = 0.03 at 1 year and 8.6% and 2.5% p = 0.19 at 5 years).3 Conclusion: If a patient is a prohibitive risk for open-heart surgery, having a TMVr with the MitraClip© would be as beneficial as open-heart surgery in regards to mortality even if a post-TMVr patient remains with 3+ to 4+ MR post-procedure.3 Continued follow-up will assist to further our knowledge of the TMVr procedure and its outcomes