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Comparative Study
. 2025 Apr 14;18(7):912-923.
doi: 10.1016/j.jcin.2025.02.008.

Surgical Mitral Valve Repair vs Replacement After Failed Mitral Transcatheter Edge-to-Edge Repair: The CUTTING-EDGE Registry

Mateo Marin-Cuartas  1 , Jagdip Kang  1 , Thilo Noack  1 , Manuela de la Cuesta  1 , Markus Krane  2 , Volkmar Falk  3 , Lenard Conradi  4 , Christian Hagl  5 , Maurizio Taramasso  6 , Tom C Nguyen  7 , D Scott Lim  8 , Gorav Ailawadi  9 , Michael J Mack  10 , Robert L Smith  10 , Anita W Asgar  11 , Kendra J Grubb  12 , Luigi Pirelli  13 , Paolo Denti  14 , Thomas Modine  15 , Michael J Reardon  16 , Tamim M Nazif  13 , Vinayak N Bapat  17 , Tsuyoshi Kaneko  18 , Philipp Kiefer  1 , Michael A Borger  19 , Gilbert H L Tang  20 , Syed Zaid  21 ; CUTTING-EDGE Investigators
Collaborators, Affiliations
Comparative Study

Surgical Mitral Valve Repair vs Replacement After Failed Mitral Transcatheter Edge-to-Edge Repair: The CUTTING-EDGE Registry

Mateo Marin-Cuartas et al. JACC Cardiovasc Interv. .

Abstract

Background: The impact of mitral valve (MV) surgery type after failed mitral transcatheter edge-to-edge repair (M-TEER) has not been well studied.

Objectives: The aim of this study was to compare the outcomes of MV repair vs replacement after failed M-TEER.

Methods: From 2009 to 2020, a total of 332 patients across 34 centers from the CUTTING-EDGE registry underwent MV surgery after M-TEER. Outcomes were compared between MV repair and replacement. Primary outcomes included 30-day mortality and 1-year survival after MV surgery.

Results: Among enrolled patients (mean age 73.8 ± 10.1 years, median Society of Thoracic Surgeons Predicted Risk of Mortality 3.9% [Q1-Q3: 2.2%-6.8%]), 25 (7.5%) underwent repair and 307 (92.5%) underwent replacement. The replacement group had a significantly higher rate of comorbidities, including atrial fibrillation, prior cardiac surgery, more secondary mitral regurgitation, and more devices implanted at index M-TEER (P < 0.05 for all). Replacement patients showed a trend toward higher 30-day mortality (17.7% [52 of 294] vs 4.0% [1 of 25]; P = 0.094). The observed-to-expected ratio of 30-day mortality was 3.6 (95% CI: 1.9-5.3) overall, 3.8 (95% CI: 2.1-5.5) in the replacement group, and 1.7 (95% CI: 0.7-3.3) in the repair group. Replacement patients had higher 1-year mortality (33.3% [65 of 195] vs 10.5% [2 of 19]; P = 0.041). Significantly lower survival rates were observed after replacement at 2 years (P = 0.033) and persisted in the risk-adjusted Cox regression analysis (HR for replacement: 4.24; 95% CI: 1.04-17.31; P = 0.044).

Conclusions: MV surgery after failed M-TEER is a high-risk procedure associated with higher than expected 30-day mortality, with higher mortality associated with MV replacement. Compared with repair, replacement is associated with higher 1-year mortality and a lower 2-year survival.

Keywords: mitral valve repair; mitral valve replacement; mitral valve surgery; transcatheter edge-to-edge repair.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Falk has received institutional grants from Abbott, Abiomed, Medtronic, Biotronik, and Edwards Lifesciences. Dr Conradi has served as an advisory board member for Medtronic, Abbott, and JenaValve; and has received consultant fees from Edwards Lifesciences, Boston Scientific, Venus Medtech, MicroPort, Neovasc, MicroInterventions, 4C Medical, and Pi-Cardia. Dr Hagl has received speaker honoraria from Edwards Lifesciences. Dr Taramasso has been a consultant for Abbott Vascular, Boston Scientific, Edwards Lifesciences, 4tech, Mitraltech, Simulands, MTEx, Occlufit, CoreMedic, and Shenqi Medical. Dr Nguyen has received speaker honoraria from Edwards Lifesciences, Cryolife, and Abbott. Dr Lim has received research grants accepted by his institution on his behalf from Abbott, Boston Scientific, Corvia, Edwards Lifesciences, Medtronic, V-Wave, and W.L. Gore & Associates; and has received personal consulting fees from LagunaTech, Nyra Medical, Opus, Philips, Valgen, and Venus Medtech. Dr Ailawadi has served as a consultant for Medtronic, Edwards Lifesciences, Abbott, W.L. Gore & Associates, Anteris, AtriCure, CryoLife, Johnson & Johnson, Philips, and Jena. Dr Mack has served as co–primary investigator for the PARTNER (Placement of Aortic Transcatheter Valve) trial for Edwards Lifesciences and the COAPT trial for Abbott; and has served as study chair for the APOLLO (Transcatheter Mitral Valve Replacement With the Medtronic Intrepid™ TMVR System in Patients With Severe Symptomatic Mitral Regurgitation) trial for Medtronic. Dr Asgar is a consultant for Medtronic, Abbott, Edwards Lifesciences, and W.L. Gore & Associates; and has received research grants from Abbott. Dr Grubb is a physician proctor for Medtronic; and has severed as a consultant for Medtronic, Boston Scientific, Abbott, Ancora, OpSens Medical, and 4C Medical. Dr Pirelli is a physician proctor for and has received speaker honoraria from Edwards Lifesciences and Abbott; and is a consultant for Medtronic. Dr Denti has received speaker honoraria from Abbott and Edwards Lifesciences; and has received consultant fees from Approxima, HVR, InnovHeart and Pi-Cardia. Dr Modine is a physician proctor and consultant for Medtronic, Edwards Lifesciences, and Abbott. Dr Reardon is a consultant for Medtronic, Boston Scientific, Abbott, and W.L. Gore & Associates. Dr Nazif has equity in Venus Medtech; and has received consulting fees or honoraria from Keystone Heart, Edwards Lifesciences, Medtronic, and Boston Scientific. Dr Bapat has served as a consultant for Medtronic, Edwards Lifesciences, 4C Medical, and Boston Scientific. Dr Kaneko is a speaker for Edwards Lifesciences, Medtronic, Abbott, and Baylis Medical; and is a consultant for 4C Medical. Dr Borger’s hospital has received speaker honoraria and/or consulting fees on his behalf from Edwards Lifesciences, Medtronic, Abbott, and Artivion. Dr Tang has received speaker honoraria and served as a physician proctor, consultant, advisory board member, TAVR publications committee member, APOLLO trial screening committee member, and IMPACT MR steering committee member for Medtronic; has received speaker honoraria and served as a physician proctor, consultant, advisory board member, and TRILUMINATE trial anatomic eligibility and publications committee member for Abbott Structural Heart; has served as an advisory board member for Boston Scientific and JenaValve; has served as a consultant for NeoChord, Shockwave Medical, Peija Medical, and Shenqi Medical Technology; and has received speaker honoraria from Siemens Healthineers. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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