Article ; Online: Patient Risk-Benefit Preferences for Transcatheter Versus Surgical Mitral Valve Repair.
Journal of the American Heart Association
2024 Volume 13, Issue 6, Page(s) e032807
Abstract: Background: Transcatheter edge-to-edge repair (TEER) of mitral regurgitation is less invasive than surgery but has greater 5-year mortality and reintervention risks, and leads to smaller improvements in physical functioning. The study objective was to ... ...
| Abstract | Background: Transcatheter edge-to-edge repair (TEER) of mitral regurgitation is less invasive than surgery but has greater 5-year mortality and reintervention risks, and leads to smaller improvements in physical functioning. The study objective was to quantify patient preferences for risk-benefit trade-offs associated with TEER and surgery. Methods and results: A discrete choice experiment survey was administered to patients with mitral regurgitation. Attributes included procedure type; 30-day mortality risk; 5-year mortality risk and physical functioning for 5 years; number of hospitalizations in the next 5 years; and risk of additional surgery in the next 5 years. A mixed-logit regression model was fit to estimate preference weights. Two hundred one individuals completed the survey: 63% were female and mean age was 74 years. On average, respondents preferred TEER over surgery. To undergo a less invasive procedure (ie, TEER), respondents would accept up to a 13.3% (95% CI, 8.7%-18.5%) increase in reintervention risk above a baseline of 10%, 4.6 (95% CI, 3.1-6.2) more hospitalizations above a baseline of 1, a 10.7% (95% CI, 6.5%-14.5%) increase in 5-year mortality risk above a baseline of 20%, or more limited physical functioning representing nearly 1 New York Heart Association class (0.7 [95% CI, 0.4-1.1]) over 5 years. Conclusions: Patients in general preferred TEER over surgery. When holding constant all other factors, a functional improvement from New York Heart Association class III to class I maintained over 5 years would be needed, on average, for patients to prefer surgery over TEER. |
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| MeSH term(s) | Humans ; Female ; Aged ; Male ; Mitral Valve/surgery ; Mitral Valve Insufficiency/surgery ; Patient Preference ; Cardiac Surgical Procedures/adverse effects ; Hospitalization ; Treatment Outcome ; Heart Valve Prosthesis Implantation/adverse effects |
| Language | English |
| Publishing date | 2024-03-12 |
| Publishing country | England |
| Document type | Journal Article |
| ZDB-ID | 2653953-6 |
| ISSN | 2047-9980 ; 2047-9980 |
| ISSN (online) | 2047-9980 |
| ISSN | 2047-9980 |
| DOI | 10.1161/JAHA.123.032807 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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