Outcomes in patients undergoing transcatheter edge-to-edge mitral valve repair as compared to a general and heart failure population

Background

Information on the use of transcatheter edge-to-edge repair (TEER) in severe mitral regurgitation in national settings is still scarce.

Aims

To compare patient characteristics and one-year rate of all-cause mortality and heart failure (HF) hospitalization in a nationwide cohort of patients undergoing TEER for mitral regurgitation with controls from the background population and patients with HF.

Methods

Using Danish nationwide registries, all patients with first-time TEER (2011−2020) were identified and matched to the background population and a population with first-time admissions with HF on sex, age, and calendar year on a 1:4 ratio. Adverse outcome was assessed using cumulative incidence plots and adjusted Cox regression analyses.

Results

We included 423 patients undergoing TEER and two matched control cohorts consisting of 1692 people each. Median age was 76 years (interquartile range: 70–84) with a majority being male (62.9 %). Patients treated with TEER had a considerable burden of comorbidities: chronic HF (63.1 %), atrial fibrillation (57.9 %), and diabetes mellitus (20.8 %). Use of loop diuretics in the TEER- and HF-group was 84.6 % and 39.7 %, respectively. In the TEER-group the one-year cumulative incidence rate for all-cause mortality was 21.3 % and 31.2 % for HF-hospitalization. Compared with the TEER-group: one-year all-cause mortality (background-cohort: adjusted hazard ratio [HR] 0.23 (95 % CI): 0.17–0.31], HF-cohort: HR 1.33 [95 % CI: 1.05–1.68]); one-year HF-hospitalization (background-cohort: HR 0.04 [95 % CI: 0.02–0.07], HF-cohort: HR 1.11 [95 % CI: 0.90–1.36]).

Conclusions

Patients undergoing TEER in Denmark are comorbid compared to the background population and have a higher index degree of symptomatic HF with a lower mortality than a matched cohort of HF patients.