Transcatheter treatments catching up to surgical mitral valve repair

The use of transcatheter mitral valve repair (TMVR) systems continues to grow rapidly nearly six years after the FDA approved the U.S.'s first such treatment, according to research published in the American Journal of Cardiology. In contrast, rates of surgical mitral valve repair (SMVR) have remained steady.

With a nearly 10 percent prevalence, moderate to severe mitral regurgitation (MR) is a commonality in U.S. populations, Tanush Gupta, MD, and co-authors said in the journal.

“Surgery with either mitral valve repair or replacement is generally recommended for patients with severe MR to improve symptoms and survival,” Gupta, of Albert Einstein College of Medicine in New York, et al. wrote. “However, around 50 percent of patients with severe MR requiring surgery are turned down due to increased perioperative risk owing to advanced age, frailty, left ventricular dysfunction and comorbidities.”

TMVR technologies like the MitraClip system, approved by the FDA in 2013 and proven effective in last year’s “blockbuster” COAPT trial, have answered the demand for more accessible MR solutions, the authors said. Still, while TMVR records are typically logged in CMS databases, nobody tracks the incidence of isolated SMVRs.

For their study, Gupta and colleagues pulled National Inpatient Sample data for all patients aged 65 and up who underwent isolated TMVR or SMVR between 2013 and 2015. Patients undergoing concomitant coronary bypass grafting or other valvular surgery were excluded from the SMVR group.

Of the 11,615 patients the team identified, 72.3 percent underwent SMVR, while 27.7 percent underwent TMVR. The total number of MVRs increased linearly, from 1,180 in 2013 to 1,795 in 2015—a rise the authors said was driven partly by a “dramatic” increase in the number of TMVR treatments (90 to 690) while SMVR treatments stayed the same (a total increase of just 15 surgeries over two years).

According to Gupta and co-authors’ data, the proportion of TMVRs increased with age. Between 2013 and 2015, TMVR interventions comprised 12.1 percent of MVRs in those aged 65 to 74; 34.5 percent of MVRs in 75- to 84-year-olds; and 75.4 percent of MVRs in patients aged 84 and up. In comparison, the number of isolated SMVRs increased modestly in patients aged 65 to 74 but remained steady in those aged 75 and older.

“These observations highlight a previously undertreated or untreated population of MR patients that were not suitable candidates for surgery and are now being treated with TMVR,” the authors wrote. “Our results also underscore that the adoption of the MitraClip technology has complemented and not supplanted SMVR.

“With the advent of newer transcatheter treatments targeting annular reduction and subvalvular apparatus, percutaneous MVR therapies are poised to grow further in the coming years.”