Abstract
Background: Transcatheter edge-to-edge repair (TEER) for mitral regurgitation has rapidly progressed. The MitraClip® system underwent stepwise improvements between 2016 and 2019 (second to fourth generation).
However, real-world data on peri-procedural outcomes remain limited. We analyzed peri-procedural healthcare resource utilization and safety of TEER with the MitraClip® system in the U.S. between 2016 and 2019.
Methods: Primary outcomes (healthcare resource utilization) included hospital length of stay (LOS), adverse
discharge to a short-term hospital or skilled nursing facility and hospital costs. Secondary outcomes (safety) were in-hospital mortality and post-procedural complications.
Results: A total of 5,212 adults underwent mitral TEER. Mean age was 77.7 (±10.1) years; 3,645 patients (69.9
%) were over 75 years. Median Charlson Comorbidity Index was 3 [IQR 1–4], number of cardiovascular risk
factors 3 [2–4], CHA2DS2-VASc score 4 [3–5] and simplified HAS-BLED score 2 [2–3]. Most procedures were
performed at large hospitals (76.0 %) and regional hubs on both U.S. coasts. Between 2016 and 2019, LOS
decreased by 21 % (95 % CI 0.79–0.85), adverse discharges by 41 % (95 % CI 0.45–0.78) and hospital costs by 8
% (95 % CI 0.88–0.95). TEER showed favorable safety: vascular complications, ischemic strokes, cardiac arrests
and tamponades each <1 %; mortality 1.6 %, bleeding 3.3 % and cardiogenic shock 4.5 %. The composite safety
outcome declined by 27 % (95 % CI 0.59–0.91). All adverse outcomes increased linearly with increasing co morbidity burden (P for trend < 0.001).
Conclusion: Mitral TEER has become safer and more efficient due to technological advances, operator experience and centralized care. Caution is advised in highly comorbid patients.
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