Readmission Trends and Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Regurgitation With and Without Atrial Fibrillation: A Propensity-Matched National Readmission Analysis

Saliha Erdem; Amro Taha; Neel Patel; Anoop Titus; Muhammad Aamir; Yasemin Bahar; Yasar Sattar; Khola Waheed Khan; Waleed Alruwaili; Aneeza Jamshed; Nagib Chalfoun; Islam Y. Elgendy; M. Chadi Alraies

doi:10.1097/hpc.0000000000000393

May 14, 2025Critical Pathways in Cardiology A Journal of Evidence-Based Medicine

Readmission Trends and Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Regurgitation With and Without Atrial Fibrillation: A Propensity-Matched National Readmission Analysis

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Why the study?

Outcomes and readmission trends of transcatheter edge-to-edge repair (TEER) for symptomatic mitral regurgitation in patients with atrial fibrillation remain unknown.

Does comorbid atrial fibrillation worsen in-hospital outcomes and readmission rates in patients undergoing transcatheter edge-to-edge repair for symptomatic mitral regurgitation?

Structured PICO

Does comorbid atrial fibrillation worsen in-hospital outcomes and readmission rates in patients undergoing transcatheter edge-to-edge repair for symptomatic mitral regurgitation?

P

Population

39,867 patients undergoing transcatheter edge-to-edge repair (TEER) for symptomatic mitral regurgitation, including 24,729 (62%) with atrial fibrillation and 15,138 (38%) without atrial fibrillation.

I

Intervention

Transcatheter edge-to-edge repair (TEER) in the presence of comorbid atrial fibrillation (AF).

C

Comparator

Transcatheter edge-to-edge repair (TEER) in patients without atrial fibrillation.

O

Outcome

Inhospital mortality, acute kidney injury (AKI), heart failure (HF), acute stroke, myocardial infarction, postprocedure bleeding, and cardiac tamponade.hard clinical

Implication

In patients undergoing TEER for mitral regurgitation, concomitant atrial fibrillation is associated with worse periprocedural outcomes including higher inpatient mortality and heart failure, though readmission rates up to 180 days remain similar.

Abstract

BACKGROUND: The use of transcatheter edge-to-edge repair (TEER) for symptomatic mitral regurgitation is steadily increasing. However, the outcomes of TEER among patients with atrial fibrillation (AF), including readmission trends, remain unknown. METHODS: The Nationwide Readmissions Database was queried between 2016 and 2020 to identify TEER patients with and without AF. The 2 groups were then compared using propensity score matching and multivariate regression models. The outcomes included inhospital mortality, ` (AKI), heart failure (HF), acute stroke, myocardial infarction, postprocedure bleeding, and cardiac tamponade. RESULTS: A total of 39,867 TEER procedure recipients were included over the study period, of which, 24,729 (62%) had AF compared to 15,138 (38%) with no AF diagnosis. On adjusted analysis, the AF group had a higher rate of inpatient mortality, AKI, HF, and postprocedural bleeding. On the contrary, TEER with AF group had lower odds of myocardial infarction. The risk of stroke and cardiac tamponade was similar between the 2 groups. The median length of stay (LOS) at index hospitalization was longer in the AF cohort in comparison with those without [2 days (interquartile range: 5-1) vs. 1 day (interquartile range: 3-1)]. CONCLUSIONS: AF in TEER procedure recipients was associated with worse outcomes including a higher rate of inpatient mortality, AKI, and HF compared with the patients without AF. Readmission rates at 30, 90, and 180 days were similar between the 2 groups.