Transcatheter Mitral Valve Repair Provides Fast, Sustained Gains in Quality of Life

SAN DIEGO, CA—For patients treated in real-world practice, transcatheter mitral valve repair (TMVR) delivers rapid improvements to quality of life that are sustained at 1 year, according to registry data presented at TCT 2018.

“Quality of life was markedly impaired prior to the procedure and, on average, improved quickly after TMVR and remained stable through 1 year,” Suzanne V. Arnold, MD, MHA (Saint Luke’s Mid America Heart Institute, Kansas City, MO), told TCT Daily via email. “I was a bit surprised to find the quality-of-life recovery to be so quick. . . . Given how minimally invasive TMVR is, perhaps the rapid improvement should have been expected.”

The researchers enrolled 4,226 patients with severe mitral regurgitation who underwent TMVR between 2013 and 2017 in the Society of Thoracic Surgeons/American College of Cardiology TVT Registry and survived through 30 days. In this cohort, the Kansas City Cardiomyopathy Questionnaire (KCCQ) score improved from 41.9 at baseline to 66.7 at 30 days (mean change, 24.8; P < 0.001) then remained stable through 1 year.

In addition, the rate of patients having a favorable outcome—defined as survival with a KCCQ score of at least 60 and without a decrease in score of 10 points or more from baseline—was 54% at 1 year.

“While the 1-year mortality rate after TMVR remains high (due to the age and comorbidities of the patients selected for TMVR), the quality of life benefits of TMVR among patients who survive appear to be fairly consistent across groups,” Arnold said.

Independent predictors of a lower 30-day KCCQ score in multivariable analysis were A-fib, prior pacemaker, severe lung disease, home oxygen, and lower KCCQ scores at baseline. Although in-hospital major bleeding and renal failure were uncommon (≤ 5%), they were linked to significant reductions in 30-day KCCQ score.

“For a procedure that is currently reserved for patients who are poor candidates for surgery, is mainly performed to improve quality of life, and has low periprocedural risk, the quality-of-life outcomes of surviving patients are encouraging and support the continued use of TMVR in selected patients who are poor candidates for cardiac surgery,” Arnold said. “If a number of risk factors for worse quality of life are present in an individual patient, these data may be helpful to improve patient selection and to better calibrate patient expectations for recovery.”

Catalyst for Research

With the move of TMVR from clinical trials to routine practice, Arnold explained that the aim of the current study was to determine what differential effects on outcomes have occurred as a result.

“Most often, the effects [of treatments] are ameliorated, to some extent, from the trials, where patients are often selected with the greatest potential for benefit and also are treated under ideal circumstances (skilled operators with both mentorship and oversight from the trial),” she said. “As such, examining the impact of treatments in real-world practice is important.”

Arnold added that while prolonging survival is important, improvement in quality of life is one of the most critical goals of TMVR treatment. “Having the larger number of patients in the TVT Registry also allowed us to examine patient and procedural factors associated with quality of life after the procedure,” she said, “which can be useful for counseling patients ahead of the procedure to set appropriate expectations.”