Implications of an off-hours setting in patients undergoing transcatheter edge-to-edge repair for mitral regurgitation

Background

Little is known about transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) that is performed outside of usual working hours. We aimed to explore the prevalence, correlates, and outcomes of mitral TEER initiated off-hours, ie, before 7:30 am, after 5:30 pm, or on weekends/holidays.

Methods

A single-center registry of isolated, first-time interventions was retrospectively analyzed in its entirety and after propensity-score matching. Outcomes included all-cause mortality, heart failure (HF) hospitalizations, and the persistence of MR and functional incapacitation along the first postprocedural year.

Results

A total of 1,177 procedures were studied. Of them, 117 (9.9%) took place off-hours. These were more often urgent interventions (30.8% vs. 14.3%, P < .001) performed in the midst of acute HF / hemodynamic compromise and on individuals with greater comorbidity, more advanced HF, and higher interventional risk. Overall procedural features were unaffected by interventional timing, and a high (>97%) technical success rate was achieved unanimously. MR severity and functional class similarly improved from baseline in the 2 study groups. Deaths and the composite of deaths or HF hospitalizations occurred earlier and more frequently following off-hours procedures (18.8% vs. 11.5%, P = .022 and 33.3% vs. 24.6%, P = .040, respectively). None of the explored endpoints’ risks were independently associated with procedural timing. Within a 234-patient, 1-to-1 matched sub-cohort, no inter-group differences were observed in pre-, intra-, and postprocedural findings and outcomes.

Conclusions

A noninfrequent procedure, off-hours mitral TEER is performed in high-risk cases but, in the hands of experienced interventionalists, should prove safe, feasible, and efficacious.