Temporal Trends in Outcomes of Nonelective Versus Elective Transcatheter Edge-to-Edge Repair of the Mitral Valve

Background

Data are limited on outcomes of elective vs nonelective mitral transcatheter edge-to-edge repair (M-TEER).

Methods

Using the National Inpatient Sample, all adult patients who had M-TEER from 2013-2020 were included in the study. Univariate and multivariate linear and logistic regression were used to evaluate outcomes.

Results

Of 43,920 patients who underwent M-TEER, with a mean age (SE) of 77 (0.13) years, 46% were women. Of these, 23% were nonelective, and 77% were elective cases. Whites were more likely to have elective, and African Americans and Hispanics were more likely to have nonelective M-TEER. In-hospital mortality and resource utilization decreased over time in elective cases, but no significant change was seen in nonelective cases. Risk-adjusted odds of in-hospital mortality were higher in nonelective vs elective cases (adjusted odds ratio, 2.85; P < .001). Risk-adjusted length of stay was also higher in nonelective vs elective cases (adjusted beta-coefficient, 7.16; P < .001). Finally, the risk-adjusted inflation-adjusted cost was also higher in nonelective vs elective cases (adjusted beta-coefficient, 23,673; P < .001).

Conclusions

Nonelective M-TEER is associated with poor outcomes. Hence, these patients should be treated in a timely fashion and should not be deferred if they meet the criteria for M-TEER. Rapid up-titration of guideline-directed medical therapy should be considered in patients with moderate to severe secondary mitral regurgitation to avoid an emergent need for transcatheter edge-to-edge repair and associated poor outcomes.