Outcomes of Percutaneous Mitral Valve Repair in Systolic Versus Diastolic Congestive Heart Failure

Abstract

IntroductionPercutaneous mitral valve repair with MitraClip device has been approved for treatment of mitral regurgitation in symptomatic patients deemed high risk for surgical repair. This study compares outcomes of Mitraclip in patients with systolic (SHF) versus diastolic heart failure (DHF). MethodsThe study population was extracted from the 2016 Nationwide Readmissions Data (NRD) using International Classification of Diseases, tenth edition, clinical modifications/procedure coding system (ICD-9-CM/PCS) codes for the Mitraclip, SHF, DHF, and procedural complications. Study endpoints included in-hospital all-cause mortality, cardiogenic shock, acute myocardial infarction (AMI), acute kidney injury (AKI), stroke, acute respiratory failure, bleeding, blood transfusion, length of hospital stay (LOS) as well as 30-day readmission rate. ResultsA total of 1681 discharges that had Mitraclip during the index hospitalization and had a history of SHF (909) or DHF (772) were included in this analysis. The mean age was 78.5 years and 46.6% were female. SHF group was associated with higher post-procedural cardiogenic shock (7.3% versus 2.0%, p < 0.01), AMI (2.1% versus 0.8%, p = 0.03), AKI (21.0 versus 14.2%, p < 0.01), acute respiratory failure (13.2% versus 9.6%, p = 0.02), and longer LOS (9.6 versus 5.7 days, p < 0.01). There were no significant differences between groups in terms of in-hospital all-cause mortality (3.4% versus 2.3%, p = 0.18), stroke (0.7% versus 1.4%, p = 0.15), bleeding (10.7% versus 8.9%, p = 0.23), need for blood transfusion (5.7% versus 3.6%, p = 0.05), or 30-day readmission rate (15.7% versus 16.1%, p = 0.86). ConclusionsIn comparison to DHF, patients with SHF undergoing the MitraClip had higher in-hospital morbidities and longer LOS but comparable mortality and 30-day readmission rates.