A nationwide analysis of resource utilization and safety in patients undergoing mitral transcatheter edge-to-edge repair.

BACKGROUND

Transcatheter edge-to-edge repair (TEER) for mitral regurgitation has rapidly progressed. The MitraClip® system underwent stepwise improvements between 2016 and 2019 (second to fourth generation). However, real-world data on -procedural outcomes remain limited. We analyzed -procedural healthcare resource utilization and safety of TEER with the MitraClip® system in the U.S. between 2016 and 2019.

METHODS

Primary outcomes (healthcare resource utilization) included hospital length of stay (LOS), adverse discharge to a short-term hospital or skilled nursing facility and hospital costs. Secondary outcomes (safety) were in-hospital mortality and post-procedural complications.

RESULTS

A total of 5,212 adults underwent mitral TEER. Mean age was 77.7 (±10.1) years; 3,645 patients (69.9 %) were over 75 years. Median Charlson Comorbidity Index was 3 [IQR 1-4], number of cardiovascular risk factors 3 [2-4], CHADS-VASc score 4 [3-5] and simplified HAS-BLED score 2 [2-3]. Most procedures were performed at large hospitals (76.0 %) and regional hubs on both U.S. coasts. Between 2016 and 2019, LOS decreased by 21 % (95 % CI 0.79-0.85), adverse discharges by 41 % (95 % CI 0.45-0.78) and hospital costs by 8 % (95 % CI 0.88-0.95). TEER showed favorable safety: vascular complications, ischemic strokes, cardiac arrests and tamponades each <1 %; mortality 1.6 %, bleeding 3.3 % and cardiogenic shock 4.5 %. The composite safety outcome declined by 27 % (95 % CI 0.59-0.91). All adverse outcomes increased linearly with increasing comorbidity burden (P for trend < 0.001).

CONCLUSION

Mitral TEER has become safer and more efficient due to technological advances, operator experience and centralized care. Caution is advised in highly comorbid patients.