Eastern Cardiothoracic Surgical Society

Propensity-Matched Comparison of Open Aortic and Mitral Replacement or Repair Versus Transcatheter Aortic Valve Replacement in Patients with Significant Mitral Regurgitation
Fenton McCarthy, Nimesh Desai, Prashanth Vallabhajosyula, Zachary Fox, Rohan Menon, Justin George, Saif Anwaruddin, Howard Hermann, Joseph Bavaria, Wilson Szeto, Hospital of the University of Pennsylvania, Philadelphia, PA

OBJECTIVE: For patients being considered for Transcatheter Aortic Valve Replacement (TAVR), significant pre and postoperative mitral regurgitation (MR) has been associated with worse outcomes. It remains unknown whether isolated TAVR or combined aortic valve and mitral valve replacement/repair (AVR/MVR) is better. We propensity-matched patients to compare AVR/MVR to TAVR in patients presenting with significant MR.

METHODS: We evaluated all patients presenting with greater than mild MR undergoing either TAVR or AVR and MVR at a single institution from 2002-2012. Patients with pre-operative endocarditis were excluded. Out of 306 patients in the AVR/MVR group and 147 patients in the TAVR group, propensity analysis matched 40 pairs of patients. Standard univariate, logistic regression, Cox regression, and propensity matching techniques were used.

RESULTS: There was no difference in the preoperative average age (76 7.4 v 78 6.9, p=0.68), ejection fraction (53 15 v 51 17, p=0.68), STS score (9.9 3.1 v 9.3 3.4, p=0.61) or 30 day mortality (7.5% v 2.5%, p=0.6) between the matched pairs of open AVR/MVR and TAVR patients. There was an increased number of urgent operations in the open AVR/MVR versus TAVR group (87.5% v 67%, p =0.01), less NYHA III/IV (75% v. 95%, p=0.003), and less hypertension (70% v. 95%, p=0.03). Amongst 30-day survivors, long-term survival was significantly better in the AVR/MVR group compared to TAVR. (p=0.04). See Figure 1.

CONCLUSIONS: In a propensity matched analysis of patients presenting with significant MR, open AVR/MVR and TAVR had equivalent perioperative outcomes, but open AVR/MVR had superior long-term survival when compared to TAVR.