Abstract 11880: Outcomes of Transcatheter Rheumatic Mitral Valve Repair

Abstract

Introduction: The aim of this analysis was to investigate if mitral transcatheter edge-to-edge repair (TEER) presents a safe and effective option for patients with severe symptomatic rheumatic mitral regurgitation. Hypothesis: Mitral TEER in rheumatic valvular disease (RVD) is challenging due to leaflet thickening and calcification but is performed in select cases. Limited data exists on its outcomes. Methods: We queried the Nationwide Readmissions Database for hospitalizations for mitral TEER in the United States between 2016 and 2018. Propensity score weighted regression analysis was conducted to evaluate the association of RVD with in-hospital outcomes and 90-day readmissions after mitral TEER. Results: A total of 18,240 mitral TEER procedures were included in analysis, including 1,779 (10%) in patients with RVD. Mitral TEER in patients with RVD was associated with no difference in overall in-hospital mortality compared to patients without RVD (odds ratio [OR] 1.47, 95% confidence interval [CI] 0.94-2.30, p 0.089). However, RVD was associated with higher in-hospital acute myocardial infarction (OR 1.65, 95%CI 1.07-2.56), acute kidney injury (OR 1.58, 95%CI 1.30-1.94), ventricular arrhythmia (OR 1.50, 95%CI 1.12-2.01), high-degree heart block (OR 1.67, 95%CI 1.25-2.23) and conversion to open surgical repair or replacement (OR 2.53, 95%CI 1.02-6.30). Mitral TEER in RVD was also associated with higher 90-day all-cause readmission (hazard ratio [HR] 1.19, 95% CI 1.04-1.47, p 0.012), although there was no difference in heart failure readmission or readmission for surgical repair/replacement. Conclusions: Mitral TEER might be a reasonable option for carefully selected patients with RVD at very high surgical risk who also have favorable anatomy.