Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair Mid-Term Outcomes From the CUTTING-EDGE International Registry

objectives the aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER). background although>100,000mitralTEER procedures have beenperformedworldwide, longitudinal data on MV surgery after TEER are lacking. methods datafrom the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. clinical and echocardiographic outcomes were evaluated. median follow-up duration was 9.0 months (interquartile range [IQR]: 1.225.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year. results from july 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. the mean age was 73.8 10.1 years, median society of thoracic surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. the median interval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median society of thoracic surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. the 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. on kaplan-meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery. conclusions Inthis first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only <10% of patients underwent MV repair. these registry data provide valuable insights for further research to improve these outcomes.