Transcatheter Mitral Valve Repair Procedures Research Articles

Feasibility of Same-Day Discharge Approach After Transcatheter Mitral Valve Repair Procedures: One-Year Follow-Up Outcomes

Feasibility of Same-Day Discharge Approach After Transcatheter Mitral Valve Repair Procedures: One-Year Follow-Up Outcomes

Gender differences in the discharge outcomes post-TMVR among us patients 65 years and above: a review of 4,678 patients from the national inpatient sample

Abstract Funding Acknowledgements Type of funding sources: None. Background Though the Transcatheter mitral valve repair (TMVR) procedure has been shown to be beneficial among patients with moderate to severe mitral regurgitation, the effect of sex on the discharge outcomes post-TMVR remains unclear. Purpose We evaluated the gender differences in the outcomes, including death, next-day discharge, and discharge disposition among patients who underwent TMVR in the United States National Inpatient Sample (NIS) Database. We hypothesized that there would be no difference in the outcome of TMVR by gender in this study population. Methods Using the United States NIS Database 2016 – 2019, we identified all patients aged ≥ 65 years with a first listed ICD-10 procedure code of 02UG3JZ corresponding to the TMVR procedure. We classified patients with length of stay (LOS) ≤ 1 day as next day discharge (NDD) and LOS >1 day as non-NDD. Discharge disposition was classified as home/short-term facility, long term facility, or death. Home/short-term facility was defined as patients who were discharged to home, to a short-term hospital, against medical advice, alive with an unknown destination, to home health care, or transferred to court/law enforcement. Disposition was defined as long-term facility if patients were discharged to a skilled nursing facility or intermediate care facility, or another type of facility. Multivariable logistic regression was used to estimate the odds of death and non-NDD, comparing all male patients who had a TMVR to all female patients who underwent TMVR adjusting for age, race, sex, Charlson Co-morbidity Index (CCI) score, median household income, primary insurance, hospital region, teaching status of the hospital and hospital bed size. Results Our study included 4,678 patients (mean age ± SD = 80.4 ± 6.8) who had TMVR between 2016 to 2019. In our study population, 47.5% were females (mean age ± SD = 80.7 ± 6.7) and 52.5% (mean age ± SD = 80.0 ± 6.8) were males. The mean CCI score was lower in females compared to men (mean CCI score ± SD = 2.8 ± 1.9 vs. 3.2 ± 2.0; p<0.0001). Of the seventy-four (74) patients that died, 42 (56.8%) were female and 32 (43.2%) were male (p=0.10). Males were more likely to be discharged to a home/short-term facility than females (53.8% vs. 46.2%; p<0.0001), while females were more likely to be discharged to a long-term facility than males (57.3% vs. 42.7%; p<0.0001). Males were more likely to be discharged within the next day than females (56.1% vs. 43.9%; p<0.0001). Compared to males, females had a higher odds of death (odds ratio (OR), 1.71 [95% CI, 1.03-2.83]; p=0.04) post-TMVR. Females also had higher odds of non-NDD compared to their male counterparts (odds ratio (OR), 1.42 [95% CI, 1.25-1.60]; p<0.0001) post-TMVR. Conclusion Among patients aged 65 years and above who had a TMVR procedure, females were more likely to be discharged to a long-term facility and had higher odds of death and non-next-day discharge than males.

Transcatheter Mitral Valve Repair with MitraClip®: A Nationwide Experience.

Transcatheter mitral valve repair (TMVr), using MitraClip®, is a safe and effective procedure for severe mitral valve regurgitation (MR). However, the therapeutic results of MitraClip® in Qatar remain to be elucidated. A total of 25 patients (mean age 60 ± 14.5 years, 64% males) with symptomatic severe MR and prohibitive surgical risks were enrolled in this study. The procedural success rate was 92% to achieve mild residual MR. There was no periprocedural death. All patients experienced significant improvement in heart failure symptoms and MR grade postprocedure with sustained improvement over 1-year follow-up. The TMVr procedure using the MitraClip® device was safe and resulted in meaningful and sustained functional status and echocardiographic parameter improvement.

Under-representation of Women as Proceduralists and Patients in TAVR and TMVr Procedures: Data, Implications and Proposed Solutions.

Women are under-represented among transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVr) operators. This review assesses the representation of women as patients and as proceduralists and trial authors in major structural interventions. Women are under-represented as proceduralists in structural interventions: only 2% of TAVR operators and 1% of TMVr operators are women. Only 1.5% of authors in landmark clinical TAVR and TMVr trials are interventional cardiologists who are women (4/260). Significant under-representation and under-enrolment of women in landmark TAVR trials is evident: the calculated participation-to-prevalence ratio (PPR) is 0.73, and in TMVr trials, the PPR is 0.69. Under-representation of women is also evident in registry data (PPR = 0.84 for TAVR registries and for TMVr registries). In structural interventional cardiology, women are under-represented as proceduralists, trial participants and patients. This under-representation has the potential to affect the recruitment of women to randomised trials, subsequent guideline recommendations, selection for treatment, patient outcomes and sex-specific data analysis.

Centre procedural volume and adverse in-hospital outcomes in patients undergoing percutaneous transvenous edge-to-edge mitral valve repair using MitraClip® in Germany.

The number of transcatheter mitral valve repair (TMVr) procedures has increased substantially during the last years. A better understanding of the relationship between hospital volume of transcatheter transvenous mitral valve repairs using MitraClip® and patient outcomes may provide information for future policy decisions to improve patient management. We analysed patient characteristics and in-hospital outcomes for all TMVr procedures using MitraClip® performed in Germany from 2011 to 2017. Hospitals were stratified according to centre volumes and patients were compared for baseline characteristics and adverse in-hospital events. Overall, 24 709 inpatients were treated during the observational period. Patients treated in centres with a volume of ≤10 procedures annually developed more often pulmonary embolism (odds ratio 2.22, 95% confidence interval 1.19-4.13; P=0.012) compared to those treated in centres with a volume of >10 procedures annually, whereas no association of centre volume (≤10 or >10) was found with in-hospital mortality (P=0.728). Although patients treated in centres with an annual volume >25 TMVr procedures had higher numbers of comorbidities compared to those treated in centres with an annual volume of ≤25 TMVr procedures, in-hospital mortality did not differ (3.6% vs. 3.5%, P=0.485). Similarly, when centre volumes were stratified for ≤50 vs. >50 procedural volumes, no association with in-hospital mortality was recorded (P=0.792). A lower rate of mitral valve surgery after MitraClip® was observed over time, particularly in high-volume centres. Annual numbers of MitraClip® implantations increased from 2011 to 2017 in Germany, whereas in-hospital mortality remained stable. Although patients treated in high-volume centres had a more unfavourable risk profile, in-hospital mortality was comparable to that of low-volume centres.

Association Between Hospital Cardiovascular Procedural Volumes and Transcatheter Mitral Valve Repair Outcomes

BackgroundCardiovascular procedural volumes can serve as metrics of hospital infrastructure and quality, and are the basis for thresholds for initiating transcatheter mitral valve repair (TMVr) programs. Whether hospital volumes of TMVr, surgical mitral valve replacement or repair (SMVRr), and percutaneous coronary intervention (PCI) are indicators of TMVr quality of care is not known. MethodsWe used the 2017 Nationwide Readmissions Database to identify hospitals that performed at least 5 TMVr procedures. Hospitals were divided into quartiles of TMVr volume. Associations of hospital TMVr, SMVRr, and PCI volumes, as well as SMVRr and PCI outcomes with TMVr outcomes were examined. Outcomes studied were risk-standardized in-hospital mortality rate (RSMR) and 30-day readmission rate (RSRR). ResultsThe study included 3404 TMVr procedures performed across 150 hospitals in the US. The median hospital TMVr volume was 17 (IQR 10, 28). The mean hospital-level RSMR and RSRR for TMVr were 3.0% (95% CI 2.5%, 3.4%) and 14.8% (95% CI 14.5%, 15.0%), respectively. There was no significant association between hospital TMVr volume (as quartiles or as a continuous variable) and TMVr RSMR or RSRR (P > 0.05). Similarly, there was weak or no correlation between hospital SMVRr and PCI volumes and outcomes with TMVr RSMR or RSRR (Pearson correlation coefficients, r = −0.199 to 0.269). ConclusionIn this study, we found no relationship between hospital TMVr, SMVRr, and PCI volume and TMVr outcomes. Further studies are needed to determine more appropriate structure and process measures to assess the performance of established and new TMVr centers.

Relation of Institutional Mitral Valve Surgical Volume to Surgical and Transcatheter Outcomes in Medicare Patients

There are limited data to support proposed increases to the minimum institutional mitral valve (MV) surgery volume required to begin a transcatheter mitral valve repair (TMVr) program. The current study examined the association between institutional MV procedure volumes and outcomes. All 2017 Medicare fee-for-service patients who received a TMVr or MV surgery procedure were included and analyzed separately. The exposure was institutional MV surgery volume: low (1 to 24), medium (25 to 39) or high (40+). Outcomes were in-hospital mortality and 1-year postdischarge mortality and cardiovascular rehospitalization. For MV surgery patients, in-hospital mortality rates were 6.4% at low-volume, 8.7% at medium-volume and 9.8% at high-volume facilities. Rates were significantly higher for low-volume [OR = 1.50, 95% CI (1.23 to 1.84)] and medium-volume [OR = 1.33, 95% CI (1.06 to 1.67)] compared with high-volume facilities. There was no statistically significant relationship between institutional MV surgery volume and in-hospital mortality for TMVr patients, either at low-volume [OR = 1.52, 95% CI (0.56, 4.13)] or medium-volume [OR = 1.58, 95% CI (0.82, 3.02)] facilities, compared with high-volume facilities. Across all volume categories, in-hospital mortality rates for TMVr patients were relatively low (2.3% on average). For both cohorts, the rates of 1-year mortality and cardiovascular rehospitalizations were not significantly higher at low- or medium-volume MV surgery facilities, as compared with high-volume. In conclusion, among Medicare patients, there was a relation between institutional MV surgery volume and in-hospital mortality for MV surgery patients, but not for TMVr patients.

Impact of Right Ventricular Dysfunction on Outcomes After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation

ObjectivesThis study sought to assess the impact of right ventricular dysfunction (RVD) as defined by impaired right ventricular-to-pulmonary artery (RV-PA) coupling, on survival after edge-to-edge transcatheter mitral valve repair (TMVR) for severe secondary mitral regurgitation (SMR). BackgroundConflicting data exist regarding the benefit of TMVR in severe SMR. A possible explanation could be differences in RVD. MethodsUsing data from the EuroSMR (European Registry on Outcomes in Secondary Mitral Regurgitation) registry, this study compared the characteristics and outcomes of SMR patients undergoing TMVR, according to their RV-PA coupling, assessed by tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure (TAPSE/sPAP) ratio. ResultsOverall, 817 patients with severe SMR and available RV-PA coupling assessment underwent TMVR in the participating centers. RVD was present in 211 patients (25.8% with a TAPSE/sPAP ratio <0.274 mm/mm Hg). Although all patients demonstrated significant improvement in their New York Heart Association (NYHA) functional class, there was a trend toward a lower rate of NYHA functional class I or II among patients with RVD (56.5% vs. 65.5%, respectively; p = 0.086) after TMVR. Survival rates at 1 and 2 years were lower among patients with RVD (70.2% vs. 84.0%, respectively; p < 0.001; and 53.4% vs. 73.1%, respectively; p < 0.001). On multivariate analysis, a reduced TAPSE/sPAP ratio was a strong predictor of mortality (odds ratio: 1.62; 95% confidence interval: 1.14 to 2.31; p = 0.007). ConclusionsRVD, as shown by impairment of RV-PA coupling, is a major predictor of adverse outcome in patients undergoing TMVR for severe SMR. The often neglected functional and anatomic RV parameters should be systematically assessed when planning TMVR procedures for patients with severe SMR.

Acquired von Willebrand syndrome and factor VIII in patients with moderate to severe mitral regurgitation undergoing transcatheter mitral valve repair.

Background and HypothesisThe acquired von Willebrand syndrome (AvWS), which predisposes to bleeding events, is often related to valvular heart diseases. We investigated possible implications of AvWS and factor VIII levels in patients with moderate to severe mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR).Methods and Results123 patients with moderate to severe MR were prospectively enrolled. Complete measurements of von Willebrand Factor activity (vWFAct), von Willebrand Factor antigen (vWFAg), and factor VIII expression before and 4 weeks after TMVR were available in 85 patients. At baseline, seven patients had a history of gastrointestinal bleeding, two patients suffered bleeding events during their hospital stay, and one patient had a bleeding 4 weeks after TMVR. Even though vWFAct, vWFAct/vWFAg ratio and vWFAg values did not change after TMVR, we observed a significantly lower vWFAct/vWFAg ratio in patients with primary MR as compared to patients with secondary MR both at baseline (p = 0.022) and 4 weeks following the TMVR procedure (p = 0.003). Additionally, patients with a mean mitral valve gradient ≥4 mmHg after TMVR had significantly lower vWFAct/vWFAg ratios as compared to patients with a mean mitral valve gradient <4 mmHg (p = 0.001).ConclusionsMR of primary etiology was associated with lower vWFAct/vWFAg ratio, hinting toward HMWM loss due to shear stress caused by eccentric regurgitation jets. In addition, morphological changes leading to postprocedural transmitral gradients ≥4 mmHg were related to lower vWFAct/vWFAg ratio 4 weeks after the procedure. Alterations of the vWFAct/vWFAg ratio in turn did not translate into a greater risk for bleeding events.

Site-Level Variability in 30-Day Patient Outcomes After Transcatheter Mitral Valve Repair in the United States.

Clinical trials have demonstrated health status benefit of transcatheter mitral valve repair (TMVr) with MitraClip in patients with mitral valve regurgitation. Real-world site-level variability in health status outcomes for TMVr, and factors associated with this variability, are unknown. All patients undergoing TMVr procedure with MitraClip between November 2013 and March 2019 in the Transcatheter Valve Therapy Registry were included. Health status was measured at baseline and 30 days with the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary (OS) score. Site-level variability in 30-day change in KCCQ-OS was examined by calculating the median odds ratio from a hierarchical logistic regression model, with ≥20-point improvement as the dependent variable. To define the extent to which patient characteristics, procedural characteristics (residual mitral valve regurgitation, periprocedural bleeding), site volume, and patients' baseline health status accounted for variability in outcomes, the proportion of variability (R2) explained by sequentially adding these variables to the model was quantified. Across 339 sites, 12 415 patients (mean age 79.0±9.5 years, 46.1%. females, 89.5% White) completed baseline and 30-day health status assessments. Mean KCCQ-OS score was 43.0±24.4 at baseline and 67.0±24.9 at 30-day follow-up. Across sites, the proportion of patients achieving a ≥20-point improvement in KCCQ-OS ranged from 12.5% to 100% and the adjusted median odds ratio was 1.58 (95% CI, 1.46-1.69). The greatest contribution to the variability in health status outcomes was from patients' baseline KCCQ-OS score (R2=25%) with <1% of the variability explained by patient and procedural characteristics, and annual site volume. There is moderate variation across sites in their patients' achievement of health status benefits from TMVr, with patient's baseline health status accounting for the largest proportion of this variation. This underscores the importance of patient selection in supporting more consistent health status benefit from TMVr.

Anemia Among Patients Undergoing Transcatheter Mitral Valve Repair: From the National Inpatient Sample in the United States.

BackgroundThe prevalence and impact of anemia on the outcomes of transcatheter mitral valve repair (TMVr) have not been well-studied. Anemia is a commonly encountered comorbidity among patients with cardiovascular disorders and is frequently under-recognized. The study aimed to analyze the prevalence of anemia and its impact on post-TMVr in-hospital outcomes.MethodsThe National Inpatient Sample (NIS) was queried to identify all patients who underwent TMVr from 2011-2015 in the United States by utilizing suitable International Classification of Diseases, Ninth Revision (ICD-9) codes. The baseline characteristics and in-hospital outcomes were compared among patients with and without anemia.ResultsA total of 4,382 patients were identified. Out of these, 978 (22.3%) patients had baseline anemia. Anemic patients were noted to have a higher burden of co-morbidities, including chronic kidney disease, hypertension, and diabetes mellitus. The in-hospital mortality was higher but not statistically significant between anemic and non-anemic patients (3.6% vs 2.6%; odds ratio (OR): 1.44; confidence interval (CI): 0.85-2.46, p=0.179). The other adverse outcomes, including the length of stay, the requirement for blood transfusions, the incidence of post-implant acute kidney injury, hemodialysis, and the cost of hospitalization, were higher in anemic patients.ConclusionAnemia was present in one out of five patients undergoing TMVr in this nationally representative cohort. Baseline anemia showed numerically higher but not statistically significant in-hospital mortality and was associated with other in-hospital adverse outcomes. Further larger studies are needed to highlight the importance of anemia in the TMVr procedure.

Prognostic Impact of Redo Transcatheter Mitral Valve Repair for Recurrent Mitral Regurgitation

There is little known about the prognostic impact of a redo transcatheter mitral valve repair (TMVR) for residual or recurrent mitral regurgitation (MR). From January 2011 to March 2019, we identified 43 consecutive patients who underwent a redo TMVR procedure with the MitraClip system. A control cohort was treated medically for MR ≥2+ after the first TMVR and was propensity score 1:1 matched using age, gender, MR severity, trans-mitral pressure gradient, and etiology of MR. To investigate the association of redo TMVR with 1-year mortality, we fitted a Cox proportional hazard model. The technical success rate of redo TMVR was 95%. A reduction in MR to ≤2+ was achieved in 79% of patients, with a significant decline of tricuspid regurgitation pressure gradient and improvement of the New York Heart Association class. After matching was performed, 43 well-matched pairs of patients were analyzed. Redo TMVR patients showed lower 1-year mortality (10.5% vs 37.6%, p = 0.01) compared with the control patients. Redo TMVR was associated with better survival (hazard ratio [HR] 0.26, 95% confidence interval [CI] 0.08 to 0.79, p = 0.02) and lower risk of the composite end point (mortality and rehospitalization due to HF: HR 0.34, 95% CI 0.15 to 0.78; p = 0.01) at 1-year follow-up. The association with the primary end point remained significant after accounting for the New York Heart Association class III/IV, TR ≥severe, the type of MR (i.e., recurrent or residual MR), or the type of previous implanted TMVR device. In conclusion, redo TMVR in selected patients with residual or recurrent MR may be associated with lower 1-year mortality than medical therapy alone.

Cardiopulmonary Exercise Testing in Percutaneous Mitral Valve Repair: A Single Centre’s Experience

Chronic severe mitral regurgitation (MR) confers negative hemodynamic consequences and long-term morbidity and mortality1. The adverse remodeling processes result in the inability of mitral valve leaflets to co-apt optimally in functional MR (FMR)2. Even after optimal medical therapy, or revascularization, FMR may not necessarily be reduced adequately. In such patients who remain persistently symptomatic from residual MR, the next course of management may be the surgical or percutaneous intervention of the mitral valve apparatus. Subsequently, percutaneous repair via transcatheter delivered systems has emerged as the treatment of choice; especially, in patients assessed to be at a high operative risk with a suitable anatomy for minimally invasive approaches to re-appose the mitral leaflets3. This has also revolutionized the approach to the management of primary mitral regurgitation (PMR), such as from mitral valve prolapse. It was treated conventionally by the surgical intervention with mitral valve repair or replacement, allowing an alternative option for the high surgical risk patients 4. In our center, the transcatheter mitral valve repair procedure (MitraClip) has been introduced in the year 2012, providing an option of percutaneous intervention to the patients where MR is unsuitable for the surgical correction. However, persistent symptoms may occur due to the concomitant non-valvular or non-cardiac pathologies, particularly chronic pulmonary diseases. Also, assessment of functional class is subjective and may be confounded by other variables, such as sedentary lifestyle, self-imposed exercise restrictions, or orthopedic conditions. The cardiopulmonary exercise test (CPET) provides an objective assessment of the exercise capacity, obviating the subjective aspects of self-reported symptoms and functional status Besides, CPET is also useful to discern pulmonary and functional status. Besides, CPET is also useful to discern pulmonary and non-cardiac contributory components of the perceived decreased functional capacity, including motivational factors. Multiple CPET parameters, related to hemodynamic surrogates before and after the MitraClip procedure, also enable a more objective evaluation of the cardiovascular impact of the repair, allowing insights into the improvements in cardiac hemodynamics post intervention7-10.

Temporal Trends and Outcomes of Transcatheter Mitral Valve Repair and Surgical Mitral Valve Intervention

BackgroundThere is a paucity of data regarding the contemporary changes in the uptake and outcomes of transcatheter mitral valve repair (TMVR) and surgical mitral valve repair/replacement (SMVR). MethodsWe queried the NIS database (2012–2016) to identify hospitalizations for TMVR and SMVR. We reported the temporal trends for uptake of TMVR and SMVR and their in-hospital outcomes. ResultsThe analysis included 77,645 hospitalizations: 8760 (11.3%) for TMVR and 68,885 (88.7%) for SMVR. Those undergoing TMVR were older and had a higher prevalence of comorbidities, but shorter length of stay (5.5 ± 8.8 vs. 14.3 ± 13.8, p < 0.001) compared with SMVR. There was a marked increase in the number of TMVRs over time (from 420 in 2012 to 3850 in 2016; +917%; Ptrend = 0.008) but a modest increase in the number of SMVRs (+117%; Ptrend = 0.02). Overall, TMVR was associated with low in-hospital mortality (2%) and favorable safety profile. After adjusting for clinical and hospital variables, there were non-significant trends towards lower adjusted mortality among TMVR and SMVR (Ptrend = 0.16 and Ptrend = 0.13, respectively). Notably, among TMVR patients, female sex was associated with lower in-hospital mortality while CKD was associated with increased in-hospital mortality. There was a significant downtrend in the incidences of cardiac arrest, hemodialysis and length of stay in TMVR patients. ConclusionReal world data showed a steady increase in the number of TMVR and SMVR procedures. Overall, TMVR was associated with low in-hospital mortality and complications rates. Despite older age and increased comorbidities, TMVR patients had lower in-hospital mortality and shorter length than their SMVR counterparts.

Racial Disparities in the Utilization and Outcomes of Transcatheter Mitral Valve Repair: Insights From a National Database

BackgroundThere is paucity of data on racial disparities in the utilization and outcomes of transcatheter mitral valve repair (TMVR). MethodsWe queried the National inpatient Sample database (2012–2016) for TMVR hospitalizations among Caucasian and African American patients. We conducted a propensity score matching analysis to compare outcomes of Caucasians versus African Americans. The main study outcome was in-hospital mortality. ResultsAmong 7940 TMVR procedures performed, 680 (8.6%) were performed in African Americans. TMVR was increasingly performed for both Caucasians and African Americans (Ptrend = 0.01), although the proportion of African Americans did not change significantly over time (Ptrend = 0.45). Compared to African Americans, Caucasians undergoing TMVR were significantly older (77.7 ± 10.8 vs. 67.2 ± 14.28, p < .001) and less likely to be women (45.3% vs.60.3%, p < .001). Caucasians undergoing TMVR had a higher in-hospital mortality compared with African Americans before matching (2.5% vs. 1.5%, odds ratio [OR] 1.75; 95% confidence interval [CI] 1.17:2.63, p = .01) as well as after matching (4.7% vs. 1.6%, OR 3.10; 95% CI 1.61:5.97, p < .001). Caucasians had higher in-hospital cardiac arrest and pacemaker insertion and shorter median length of stay. There was no difference in the incidence of other in-hospital outcomes between Caucasians and African Americans. ConclusionThis nationwide observational analysis showed a steady increase in number of TMVRs among Caucasians and African Americans. TMVR was performed in a select cohort of African Americans who were significantly younger and more likely to be women compared with Caucasians. Caucasians undergoing TMVR had higher in-hospital mortality compared with African Americans. Further research is needed to explore the reasons behind the racial disparities in the utilization and outcomes of TMVR.

Impact of the Commercial Introduction of Transcatheter Mitral Valve Repair on Mitral Surgical Practice.

BackgroundThere has been uncertainty regarding the effect of transcatheter mitral valve repair (TMVr) with MitraClip on cardiac surgical practice. Our aim was to examine the impact of the commercial introduction of TMVr to a comprehensive mitral program.Methods and ResultsWe evaluated 875 patients (aged 69±14 years; 58% men) who underwent transcatheter or mitral surgical procedures over a 6‐year period at our institution. Main outcomes were changes in surgical procedural volume after TMVr introduction and short‐term mortality for surgical and TMVr procedures. The numbers of patients treated with MitraClip, isolated mitral repair, and any mitral surgery were 249, 292, and 626 patients, respectively. Compared with surgery, patients with MitraClip were older (aged 82±8 versus 64±12 years; P<0.001) and had more severe morbidity. Following the introduction of MitraClip, surgical volumes steadily increased to a rate of 10 (95% CI, 3–7) procedures per year for isolated mitral procedures and 17 (95% CI, 13–20) procedures per year for all mitral surgeries. Both MitraClip and surgical volumes increased at the same rate (P=0.42). In‐hospital mortality was 3.2% for MitraClip and 2.1% for all mitral surgeries (P=0.33). At 30 days, survival free of all mortality (P=0.17) and freedom from heart failure rehospitalization (P=0.75) were similar for transcatheter and surgical procedures.ConclusionsThe commercial introduction of TMVr may be associated with growth in cardiac surgery, without detracting from other therapies, and favorable clinical outcomes for all treated mitral regurgitation patients. These findings demonstrate the potential benefits of complementary therapies in the treatment of patients with mitral regurgitation.

ASSOCIATION BETWEEN HOSPITAL CARDIOVASCULAR PROCEDURAL VOLUMES AND CLINICAL OUTCOMES FOLLOWING TRANSCATHETER MITRAL VALVE REPAIR

Cardiovascular (CV) procedural volumes can serve as metrics of hospital infrastructure and quality and are the basis for thresholds for initiating transcatheter mitral valve repair (TMVr) programs. Whether hospital volumes of TMVr and other CV procedures are indicators of TMVr quality of care is not

CRT-600.41 Obstructive Sleep Apnea Impacts In-Hospital Outcomes After Transcatheter Mitral Valve Repair: Insights From the National Inpatient Sample

Obstructive sleep apnea (OSA) is an independent risk factor for many cardiovascular conditions. However, the association of OSA with outcomes in patients undergoing transcatheter mitral valve repair (TMVr) has not been established. From January 2011 to September 2015, TMVr procedures among adults

CRT-600.44 Impact of Peripheral Vascular Disease After Transcatheter Mitral Valve Repair: Insights From the National Inpatient Sample

Peripheral vascular disease (PVD) is an independent predictor of poor outcomes after cardiovascular interventions and surgeries. Association of PVD with in-hospital outcomes after transcatheter mitral valve repair (TMVr) has not been studied. Adults who underwent TMVr procedures from January 2011

P5570Contemporary trends and outcomes of percutaneous and surgical mitral valve replacement or repair for mitral insufficiency in cancer patients

Abstract Importance Severe mitral valve insufficiency (MR) is managed using mitral valve replacement or repair. Transcatheter mitral valve repair (TMVR) is an emerging non-invasive treatment option for MR. Cancer patients stand to benefit from non-invasive treatment of MR given the nature of this intervention. Objective:We sought to assess the relative utilization, outcomes, and dispositions associated with TMVR vs. surgical mitral valve procedures (SMVP) in cancer patients. Methods The 2012–2015 National Inpatient Sample, a retrospective observational study was queried using ICD-9 codes for adults &gt;18 years with comorbid MR (ICD-9 – 424.0) and cancer without metastatic disease. To maintain a homogenous study population and to limit confounding, those with mitral stenosis, rheumatic disease, infective endocarditis, aortic valve disease, or those undergoing any other vascular or cardiac surgery in the same admission were excluded from the analysis. Multiple in-hospital and disposition outcomes were evaluated. Since the baseline population undergoing SMVP (ICD-9: 35.23, 35.24, 35.12) is quite different from TMVR (ICD-9: 35.97), parallel analyses for outcomes and dispositions were presented but no direct statistical comparisons. Results A total of 410,175 out of 2,449,010 patients with mitral insufficiency were found to have non-metastatic cancer (16.7%). A total of 3,600 TMVR procedures were performed during the study period. Over the study period, there has been an increase in the proportion of patients undergoing TMVR among all patients undergoing mitral valve procedures (figure). The increase is higher in cancer patients in the most recent year (14.2% vs. 8.2%, p&lt;0.0001). The four major cancers comprise of 50% of these TMVR patients. TMVR was associated with 1.4% vs. 2.2% in-hospital mortality (p=0.55), 0.7% vs. 0.8% stroke (p=0.87), 9.2% vs. 11.8% major bleeding (p=0.31), 14.1% vs. 16.5% acute kidney injury (p=0.52), 62.0% vs. 64.6% home discharge (p=0.58), and 13.3% vs. 12.0% discharge to nursing home (p=0.58) among cancer vs. non-cancer patients, respectively. On the other hand, SMVP was associated with 3.1% vs. 3.5% in-hospital mortality (p=0.35), 2.6% vs. 3.1% stroke (p=0.16), 35.0% vs. 30.5% major bleeding (p&lt;0.0001), 19.5% vs. 19.6% acute kidney injury (p=0.88), 32.8% vs. 38.6% home discharge (p&lt;0.0001), 37.2% vs. 35.0% home health care use (p&lt;0.0001), and 26.8 vs. 22.8% discharge to nursing home (p=0.05), among cancer vs. non-cancer patients respectively. TMVR percent in mitral valve procedures Conclusion TMVR utilization for MR in cancer has steadily increased in both cancer and non-cancer patients, although it is proportionately higher among cancer patients in recent years. Overall, TMVR was associated with low in-hospital mortality and a similar safety profile in cancer and non-cancer patients, while SMVP appears to have a slightly worse safety profile in cancer patients. Our findings, suggest that TMVR is a reasonable strategy in selective cancer patients with MR.