Key result
Transcatheter edge-to-edge repair of the mitral valve (TEER) was associated with a significant decrease in in-hospital mortality from 3.9% in 2014 to 2% in 2018 (P < 0.001).
Why the study?
TEER has emerged as a treatment option for high-risk patients with severe mitral regurgitation, but trends in short-term outcomes warranted investigation.
How have the utilization and short-term outcomes of TEER changed over time from 2014 to 2018 in the United States?
Observational (n=22,914)
Yes
How have the utilization and short-term outcomes of TEER changed over time from 2014 to 2018 in the United States?
Absolute Event Rate: 2% vs 3.9%
p-value: p=<0.001
TEER utilization in the US increased 4.2-fold from 2014 to 2018, accompanied by significant reductions in in-hospital mortality and 30-day heart failure readmissions despite treating a more comorbid population.
TEER short-term outcomes improved over time in higher-risk patients; leaves open whether trends reflect experience or selection effects.
Background: Transcatheter edge-to-edge repair of the mitral valve (TEER) has recently emerged as a viable treatment option in high-risk patients with severe mitral regurgitation. The present study investigated the trends in TEER short-term outcomes during 2014–2018.Methods: We performed a retrospective study using the Nationwide Readmissions Database. We analyzed data on the in-hospital and 30-day outcomes of patients who underwent TEER procedure during 2014–2018.Results: A total of 22,914 patients underwent TEER; 1,674 in 2014, 3,252 in 2015, 4,645 in 2016, 6,000 in 2017, and 7,343 in 2018 with a median age of 78, 80, 81, and 80 years, respectively, with a 4.2 fold increase in TEER utilization. Heart failure was present in 75.6%, and 83.6% of patients, in 2014, and 2018 respectively, while 73.3%, and 85.3% of patients, respectively, had hypertension. In-hospital mortality following TEER was significantly decreased from 3.9% in 2014 to 2% in 2018 (P < 0.001). Similarly, stroke rates were decreased from 1.2% in 2014 to 1% in 2018 (P = 0.093), and the median length of hospital stay was significantly shortened from 4 to 2 days (P < 0.001). The overall 30-day readmission rate was 15.3% and did not change significantly over the study period (P = 0.876); however, the 30-day HF readmission rate exhibited a significant decline from 4.7% in 2014 to 0.6% in 2018 (P < 0.001).Conclusion: Although TEER therapy is now offered to a more critically ill and larger patient population in the United States, the outcomes of patients undergoing TEER are improving with decreasing mortality, morbidity, and hospital stay.Abbreviations: TEER: Transcatheter edge-to-edge repair of the mitral valve (TEER); NRD: National Readmissions Database; MR: Mitral Regurgitation; DMR: Degenerative Mitral Regurgitation; FMR: Functional Mitral Regurgitation; HF: Heart failure; LVEF: Left Ventricular Ejection Fraction; GDMT: Guideline-Directed Management and Therapy; AKI: Acute Kidney Injury; MI: Myocardial infarction
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Abdelfattah et al. (2021) conducted an observational in Severe mitral regurgitation (n=22,914). Transcatheter edge-to-edge repair of the mitral valve (TEER) in 2018 vs. TEER in 2014 was evaluated on In-hospital mortality (p=<0.001). Transcatheter edge-to-edge repair of the mitral valve (TEER) was associated with a significant decrease in in-hospital mortality from 3.9% in 2014 to 2% in 2018 (P < 0.001).
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