MD Conference Express AHA 2011 - (Page 24)

n SELECTED UPDATES IN SURGICAL INTERVENTIONS Transcatheter Valve: New Technologies and Techniques Written by Maria Vinall The Endovascular Valve Edge-to-edge Repair Study (EVEREST II) compared the percutaneous implantation of a clip that grasps and approximates the edges of the mitral leaflets at the origin of the regurgitant jet with conventional surgery for mitral value repair [NCT00209274]. Laura Mauri, MD, Brigham and Women’s Hospital, Boston, Massachusetts, USA, concluded that percutaneous repair was less effective at reducing mitral regurgitation (MR) than conventional surgery. However, the procedure was associated with better safety and improvements in other secondary outcomes, such as left ventricular dimensions and New York Heart Association (NYHA) class [Feldman T et al. N Engl J Med 2011]. Patients with moderately severe or severe (grade 3+ or 4+) MR were randomly assigned in a 2:1 ratio to undergo either percutaneous repair (n=172) or conventional surgery (repair or replacement; n=83). The primary composite endpoint for efficacy was freedom from death, surgery for mitral valve dysfunction, and grade 3+ or 4+ MR at 1 year. The primary safety endpoint was a composite of major adverse events (MAE) within 30 days. The 1- and 2-year rates of the primary endpoint for efficacy were 55% and 52%, respectively, in the percutaneous repair group and 73% and 66% in the surgery group (p=0.007 at Year 1 and p=0.04 at Year 2; Figure 1). Figure 1. Primary Effectiveness Analysis at 1 and 2 Years (ITT Population). 100 Randomized not treated patients assigned MR 3+ or 4+ at 1 and 2 years (Percutaneous n=6; Surgery n=15) 80 * 55.2% * 73.0% ** 51.7% ** 66.3% Percent (%) Peer-Reviewed Highlights from the 60 40 20 0 1 Year 2 Years n=181 n=172 Percutaneous 1 Year n=89 Surgery 2 Years n=83 *Between group difference at 1 year (p=0.007); Exclusion of margin of 25% (p<0.001). **Between group difference at 2 years (p=0.04). Feldman T et al. N Engl J Med 2011. Reproduced with permission from L. Mauri, MD. scientificsessions.org my.americanheart.org 24 January 2012 www.mdconferencexpress.com  http://www.mdconferencexpress.com http://my.americanheart.org/professional/Sessions/ScientificSessions/Scientific-Sessions_UCM_316900_SubHomePage.jsp http://www.scientificsessions.org http://my.americanheart.org http://www.mdconferencexpress.com

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MD Conference Express AHA 2011

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