Temporal Trends of Transcatheter Edge-to-Edge Repair of the Mitral Valve Short-Term Outcomes in the United States: Nationwide Representative Study

Abstract

ABSTRACT Background: Transcatheter edge-to-edge repair of the mitral valve (TEER) has recently emerged as a viable treatment option in high-risk patients with severe mitral regurgitation. The present study investigated the trends in TEER short-term outcomes during 2014–2018. Methods: We performed a retrospective study using the Nationwide Readmissions Database. We analyzed data on the in-hospital and 30-day outcomes of patients who underwent TEER procedure during 2014–2018. Results: A total of 22,914 patients underwent TEER; 1,674 in 2014, 3,252 in 2015, 4,645 in 2016, 6,000 in 2017, and 7,343 in 2018 with a median age of 78, 80, 81, and 80 years, respectively, with a 4.2 fold increase in TEER utilization. Heart failure was present in 75.6%, and 83.6% of patients, in 2014, and 2018 respectively, while 73.3%, and 85.3% of patients, respectively, had hypertension. In-hospital mortality following TEER was significantly decreased from 3.9% in 2014 to 2% in 2018 (P < 0.001). Similarly, stroke rates were decreased from 1.2% in 2014 to 1% in 2018 (P = 0.093), and the median length of hospital stay was significantly shortened from 4 to 2 days (P < 0.001). The overall 30-day readmission rate was 15.3% and did not change significantly over the study period (P = 0.876); however, the 30-day HF readmission rate exhibited a significant decline from 4.7% in 2014 to 0.6% in 2018 (P < 0.001). Conclusion: Although TEER therapy is now offered to a more critically ill and larger patient population in the United States, the outcomes of patients undergoing TEER are improving with decreasing mortality, morbidity, and hospital stay. Abbreviations: TEER: Transcatheter edge-to-edge repair of the mitral valve (TEER); NRD: National Readmissions Database; MR: Mitral Regurgitation; DMR: Degenerative Mitral Regurgitation; FMR: Functional Mitral Regurgitation; HF: Heart failure; LVEF: Left Ventricular Ejection Fraction; GDMT: Guideline-Directed Management and Therapy; AKI: Acute Kidney Injury; MI: Myocardial infarction