Does transcatheter edge-to-edge mitral valve repair reduce 1-year rehospitalization for decompensated heart failure, and what are the predictors of readmission in patients with severe mitral regurgitation?
MitraClip implantation significantly reduces heart failure rehospitalizations at 1 year, though patients with worse baseline LVEF, troponin T, and NYHA class remain at higher risk for readmission and subsequent mortality.
BACKGROUND: In patients at increased surgical risk, transcatheter edge-to-edge mitral valve repair by MitraClip implantation for severe mitral regurgitation (MR) has proven to relieve symptoms of MR, reduce New York Heart Association (NYHA) functional class and improve quality of life. Rehospitalization for decompensated heart failure occurs frequently after MitraClip implantation, negatively impacting quality of life. We aimed here to determine predictors of 1-year rehospitalization for decompensated heart failure. METHODS AND RESULTS: A total of 355 consecutive patients who underwent MitraClip implantation at our centre were evaluated for their baseline and procedural characteristics, peri-procedural outcome and clinical endpoints. Rate of rehospitalization for decompensated heart failure was reduced from 52.7% (n = 187) in the year before MitraClip procedure to 18.0% (n = 64) (P < 0.0001) in the first year after MitraClip implantation. The mean duration until rehospitalization was 117 days after MitraClip implantation. Multivariate Cox proportional hazards regression analysis identified baseline left ventricular ejection fraction (P = 0.020), baseline troponin T (P = 0.003) and pre-procedural NYHA class (P = 0.020) as independent predictors for 1-year rehospitalization after MitraClip implantation. Rehospitalization correlated significantly with all-cause mortality (odds ratio 2.3, 95% confidence interval 1.3-4.1; P = 0.004) and cardiovascular mortality (odds ratio 3.3, 95% confidence interval 1.7-6.1; P = 0.0003). CONCLUSION: After MitraClip implantation, annual rate of rehospitalization for decompensated heart failure was reduced by 65.8%. Baseline left ventricular ejection fraction, baseline troponin T and pre-procedural NYHA functional class are independent predictors for rehospitalization within the first year after MitraClip implantation. Patients readmitted for decompensated heart failure after MitraClip implantation had a 2.3-fold increased risk of all-cause mortality and a 3.3-fold increased risk of cardiovascular mortality compared to patients not requiring rehospitalization.
Keßler et al. (Mon,) studied this question.
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