Patient Risk–Benefit Preferences for Transcatheter Versus Surgical Mitral Valve Repair

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.

Keywords

• mitral regurgitation
• mitral valve repair surgery
• transcatheter edge‐to‐edge repair