Key result
ICE-guided mitral TEER shows similar in-hospital mortality compared to TEE guidance.
Why the study?
Data on the use of ICE guidance in TEER procedures were limited to case reports and small case series.
Does intracardiac echocardiography guidance maintain safety and improve outcomes compared to transesophageal echocardiography guidance in patients undergoing mitral TEER?
Observational (n=38,770)
Yes
Does intracardiac echocardiography guidance maintain safety and improve outcomes compared to transesophageal echocardiography guidance in patients undergoing mitral TEER?
Odds Ratio: 0.83 (95% CI 0.42–1.64)
Absolute Event Rate: 2.5% vs 3%
p-value: p=0.58
ICE-guided mitral TEER is a safe and feasible alternative to TEE guidance, offering comparable in-hospital outcomes with a potentially shorter length of stay.
ICE guidance showed similar mortality to TEE in observational data; should not yet change practice and requires prospective confirmation.
Introduction: Data on use of ICE guidance in TEER procedure is limited to case reports and small case series. Our study aims to assess the feasibility, safety, utilization patterns and clinical outcomes of mitral TEER procedure with ICE guidance using a nationally representative real-world cohort of patients.Hypothesis: There is no difference between ICE-guided TEER and TEE-guided TEER in the clinical outcomes and complications. Methods: This study used the National Inpatient Sample database from quarter 4 of 2015 to 2020. We used a propensity-matched analysis and adjusted odds ratios for in-hospital outcomes/complications. A P value of <0.05 was considered significant. Results: A total of 38,770 weighted cases of mitral TEER were identified. Of the included patients 665 patients underwent ICE-guided TEER while 38,105 had TEE-guided TEER. There were no differences in the in-hospital mortality between both groups (2.5% vs. 3.0%, p=0.58). Adjusted odds of in-hospital mortality (aOR 0.83, 95%CI [0.42-1.64]) were not significantly different. There were no differences in periprocedural complications including cardiac (aOR 0.85, 95%CI [0.54-1.35]), bleeding (aOR 1.45, 95%CI [0.93-2.33]), respiratory (aOR 0.88, 95%CI [0.61-1.25]), and renal (aOR 0.89, 95%CI [0.66-1.20]) complications between patients undergoing ICE-guided versus TEE-guided TEER. There was no difference in GI complications between both groups (aOR 1.11, 95%CI [0.46-2.70]). The adjusted length of stay was less among ICE-guided TEER (median: 1 vs. 2, p<0.01) with no differences in costs of hospitalization ($137,312 vs. $153,773, p=0.06), Conclusions: In conclusion, ICE-guided mitral TEER is safe when compared with TEE guided TEER with no significant differences in in-hospital mortality, cardiac, bleeding, respiratory, and renal complications. The length of stay in ICE group is shorter as compared with the TEE group.
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Khalouf et al. (2023) conducted an observational in Mitral transcatheter edge-to-edge repair (TEER) (n=38,770). Intracardiac Echocardiography (ICE) guidance vs. Transesophageal Echocardiography (TEE) guidance was evaluated on In-hospital mortality (aOR 0.83, 95% CI 0.42-1.64, p=0.58). ICE-guided mitral TEER was associated with similar in-hospital mortality compared to TEE-guided TEER (2.5% vs. 3.0%; aOR 0.83; 95% CI 0.42-1.64; p=0.58).
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