Abstract
Introduction: Transcatheter mitral valve replacement (TMVR) is an alternative to surgical mitral valve replacement for patients at prohibitive or high surgical risk. Both transseptal TMVR and MitraClip procedures require transseptal puncture and subsequent manipulation of a catheter within the left atrium and ventricle. Hypothesis: Higher MitraClip experience leads to better procedural outcomes of transseptal TMVR. Methods: We retrospectively identified patients who underwent transseptal-TMVR using the Nationwide Readmissions Database 2016-2017. We defined hospital volume as the annual number of MitraClip cases in each hospital and categorized hospitals into high- (≥26 cases/year) and low- (<26 cases/year) volume groups by the median value. We compared the in-hospital and 30-day outcomes between the two groups. Results: A total of 1,023 TMVR patients (median 74 years; female 56.1%) were divided into the high- (n=487) and low- (n=536) volume groups. The high-volume group had a higher prevalence of prior valve implantation (30.8% vs. 24.8%; p=0.036), prior coronary artery bypass grafting (28.7% vs. 22.7%; p=0.031), and heart failure (86.7% vs. 79.5%; p=0.003) than the low-volume group. There was no significant difference in the rates of in-hospital death (9.0% vs. 9.5%; p=0.830), stroke (2.1% vs. 3.2%; p=0.330), and pacemaker implantation (2.5% vs. 4.5%; p=0.091), while surgical bailout was less frequent in the high-volume group (2.5% vs. 6.5%; p=0.002). Multivariable logistic regression analyses showed that high volume was significantly associated with a lower risk of surgical bailout, prolonged hospital stay, cardiovascular-cause readmission, but not with other outcomes including in-hospital death (Figure). Conclusions: Centers with greater MitraClip experience had a lower risk of surgical bailout, prolonged hospital stay, and early readmission after transseptal-TMVR, although mortality was high irrespective of MitraClip experience.
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