D-39 | Inpatient Outcomes of Mitral Valve Transcatheter Edge-to-Edge Repair (TEER) in Patients With Acute Decompensated Heart Failure

Abstract

TEER is a favorable alternative to surgery in patients with heart failure (HF) and mitral regurgitation (MR), but its effect in acute decompensated heart failure (ADHF) is not well studied. We aim to study the short-term outcomes of TEER in these patients using the largest US inpatient database. We queried the 2016-2019 NIS database using ICD-10 codes to identify all adult patients with MR and ADHF. Outcomes of patients who underwent TEER during index hospitalization were compared to those who did not. Multivariate logistic regression was used to compare rates of cardiogenic shock, mechanical ventilation, use of mechanical circulatory support (MCS), cardiac transplant, acute kidney injury (AKI) and need of dialysis; linear regression was used to compare length of stay (LOS). Of 1,854,806 patients with MR and ADHF, 24,905 (1.36%) underwent TEER. Overall mortality was 3.39% and was significantly lower in TEER recipients [aOR 0.39 (0.30-0.49), p<0.01]. LOS was significantly shorter in the TEER group (4 vs 5.9 days). TEER group had lower rates of mechanical ventilation [aOR 0.81 (0.70-0.94), p=0.01] and AKI [aOR 0.43 (0.39-0.47), p<0.01], although rates of AKI requiring dialysis were comparable. TEER group had significantly higher rates of cardiogenic shock. Rates of MCS were comparable except intraaortic balloon pump placement, which was more frequent in the TEER group. TEER in ADHF is associated with lower rates of inpatient mortality and mechanical ventilation, and shorter LOS. Prospective trials are needed to establish TEER as a feasible intervention in ADHF.