Surgical versus Interventional Mitral Valve Repair: Analysis of 1,100 Propensity Score-Matched Patients

Objective. We aimed to investigate outcomes in transcatheter versus surgical mitral valve repair in patients with secondary mitral regurgitation (MR) by leveraging a global, multi-institutional federated network database. Methods. Using validated ICD-10 and CPT codes, the TriNetX Analytics Research Data Network (a global federated database of electronic health records from 58 healthcare organizations) was queried to identify patients diagnosed with chronic, severe, ischemic MR and undergoing either transcatheter mitral valve repair (TMVr) or surgical mitral valve repair (SMVr) between January 1, 2015 and December 31, 2020. To adjust for baseline differences, 1 : 1 propensity score matching was performed via logistic regression using the nearest-neighbor approach and matching for 29 covariates including demographics, comorbidities, surgical history, preoperative medications, left ventricular function and heart failure status. We compared 1- and 3-year mortality rates and 1- and 3-year mitral valve reoperation rates in the matched cohorts using Kaplan-Meier estimates and adjusted Cox proportional hazards models. Results. A total of 2,352 patients met inclusion criteria (1,392 in the surgical mitral valve repair group and 960 in the TMVr group). After 1 : 1 propensity score matching, a total of 550 patients undergoing surgical mitral valve repair (SMVr) were compared to 550 patients undergoing TMVr. All characteristics were adequately matched between the cohorts (standardized mean difference <0.1). At 1- and 3-years respectively, mortality rate was 13.4% and 20.7% for surgical patients and 19.8% and 40.3% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to face mortality at 3 years (HR: 0.42, 95% CI: 0.31–0.56, $p<0.0001$ ). At 1- and 3-years respectively, mitral valve reoperation was 2.2%, and 2.4% for surgical patients and 6.6% and 7.8% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to undergo mitral valve reintervention at 3 years (HR: 0.29, 95% CI: 0.14–0.58, p = 0.0002). Conclusion. In a real-world, propensity score matching analysis of a large cohort of patients with chronic ischemic MR, surgical mitral valve repair had significantly better survival rates and significantly lower reintervention rates at 1- and 3-years compared to TMVr.