Durability and Outcomes of Mitral Reintervention After Surgical Mitral Repair in Patients 65 Years and Older in the United States.

Abstract

National data on the durability of surgical mitral repair and outcomes of reintervention are lacking. This study aimed to quantify the national incidence and outcomes of mitral reintervention after surgical repair. The US Centers for Medicare & Medicaid Services claims identified patients aged ≥65 years who underwent surgical mitral repair followed by reintervention (replacement, repeat repair, or transcatheter edge-to-edge repair [TEER]) between 2012 and 2023. The 30-day and 3-year mortality, stroke, and heart failure readmission after reintervention were assessed using logistic regression and adjusted Cox proportional hazards modeling. Competing risks were used to estimate the probability of reintervention, heart failure, and stroke. Of 45,482 patients undergoing surgical mitral repair, 1560 required reintervention. Of these, 1223 (78.4%) had surgical replacement, 164 (10.5%) underwent surgical repair, and 173 (11.1%) had TEER. The median time to reintervention was 1.9 years (interquartile range, 0.64-4.1 years). The cumulative incidence of reintervention at 9 years was 5%. The adjusted 30-day rate of heart failure readmission was lowest among patients who underwent TEER (4.8% vs 15.9% replacement, vs 14.6% repeat repair; P < .01), whereas 30-day mortality and stroke readmission rates did not differ among the reintervention approaches. At 3 years, there was no significant difference in survival, heart failure readmissions, or stroke readmissions by reintervention approach. Surgical mitral repair is durable, with a low 9-year risk of reintervention. The reintervention approach does not affect mortality, heart failure, and stroke readmissions at 3 years, a finding suggesting that any of these approaches is appropriate for reintervention.