Abstract 17886: Temporal Trends, Healthcare Resource Utilization and In Hospital Outcomes of Infective Endocarditis Following Transcatheter Edge-to-Edge Repair Using Mitraclip Among Elderly Patients With Severe Mitral Regurgitation: A National Perspectives

Abstract

Introduction: Procedural proficiency combined with the careful selection of patients with severe mitral regurgitation, who are at high or prohibitive risk for cardiac surgery, may have influenced the incidence and outcomes of infective endocarditis (IE) following mitral Transcatheter edge-to-edge repair (TEER). Objective: To assess the temporal trends, healthcare resource utilization (HRU), and in-hospital outcomes of IE post-TEER. Methods: We used the National inpatient sample registry to identify all patients aged > 65 with definite IE post-TEER between 2016 and 2020. Temporal incidence trends, in-hospital mortality, length of stay, and discharge disposition were analyzed. Results: During the study period, there were an estimated 71 cases of endocarditis among patients 65 years and older following mitral TEER, representing 355 discharges (1.0% of TEER-associated discharges) nationally. The temporal trend of the incidence of IE is shown in Figure 1. Relative to its absence, the occurrence of IE following TEER was associated with a 30.3% increased risk of HRU (Patient Average Treatment effect - PATE estimate = 0.303; 95% confidence interval (CI) =0.214 - 0.391; P<0.001); a 13.2% increased risk of AKI (PATE estimate = 0.132; 95% confidence interval (CI) =0.033 - 0.232; p=0.009) and a 6.2% increased risk of in-hospital mortality (PATE estimate = 0.062; 95% confidence interval (CI) =0.008 - 0.117; p=0.025) Conclusions: Among elderly patients with severe symptomatic mitral regurgitation, who are at high or prohibitive risk for cardiac surgery, the incidence of TEER-associated IE appears to be trending downwards. The occurrence of TEER-associated IE confers small but significant high HRU, complication rates, including AKI and in-hospital mortality, compared to those without IE. High-fidelity studies are needed to elucidate these findings.