Abstract 113: Mitral Leaflet Clip Procedure Outcomes: Analysis from the National Cardiovascular Data Registry

Abstract

Introduction: Mitral regurgitation is one of the most common valvular diseases worldwide. Treatment for severe mitral regurgitation (MR) commonly involves surgical replacement of the mitral valve, but for those who are poor surgical candidates, another option has become mitral valve repair with a mitral leaflet clip procedure (MLCP). In this study, we conducted a descriptive analysis for all patients who underwent MLCP in the United States to investigate preoperative, intraoperative, and postoperative characteristics, techniques, complications, and clinical outcomes. Methods: The National Cardiovascular Data Registry (NCDR) was used to summarize the baseline demographics and procedural quality measures of all patients who underwent MLCP between 2014 and 2017. The change in the demographics, mortality, complications, and clinical outcomes were summarized and visualized in graphs. Results: The number of subjects who underwent mitral valve repair increased from 1,023 subjects in 2014 to 5,075 in 2017. The overall mortality rates are relatively unchanged (2.6% to 2.4%). However, there was an improvement in 30-day mortality (4.5% to 4.0%). The rate of patients with low STS scores increased (34% to 50%). Overall, the rate of patients with functional MR who received mitral clips are low (&lt10%). Of note, there has been a decrease in the number of patients who are 80 years old and older (62% to 56%). Intra-operatively, there were fewer complications (14.6% to 12.2%) including fewer clips not deployed (5.3% to 3.5%) related to a decrease in leaflets not being able to be grasped. Interestingly, there was an increase in the percentage of patients with mitral valve pressure gradient &lt= 5 mmHg (71.5% to 72.5%). Regarding 30-day follow-ups, our results have shown that residual mitral valve regurgitation (moderate or greater) has decreased from 39% to 5%, with a decrease in the number of clips attempted per patient. NYHA class IV symptoms at 30 days decreased from 4.2% to 3.1%. Finally, follow up echocardiograms changed in approach, with an increase in trans-thoracic (TTE) and a decrease in trans-esophageal (TEE) (86% TEE in 2014 vs. 86% TTE in 2017). Conclusions: Our interpretation shows a trend that MLCP continues to be a viable option for MR. The rate of procedures is expected to increase especially among younger patients with low STS scores and functional MR as results of the COAPT trial. We expect a continued decrease in complications and continued intra-operative success shown by improvement in mitral regurgitation.