Transcatheter Edge to Edge Repair With MitraClip Among Renal Transplant Recipients

Outcomes of Mitral Transcatheter Edge-to-Edge Repair in Patients With Rheumatic Heart Disease

Mitral transcatheter edge-to-edge repair (TEER) in patients with rheumatic heart disease (RHD) is challenging owing to leaflet thickening and calcification but is performed in select cases. Limited data exist on its outcomes. The aim of this analysis was to investigate the safety and efficacy of mitral TEER in patients with severe symptomatic rheumatic mitral regurgitation. We queried the Nationwide Readmissions Database for hospitalizations for mitral TEER between 2016 and 2018. Propensity score-weighted regression analysis was conducted to evaluate the association of RHD with in-hospital outcomes and 90-day readmissions after mitral TEER. A total of 18,240 procedures were included in the analysis, including 1,779 in patients with RHD. Mitral TEER in patients with RHD was associated with similar in-hospital mortality to that in patients without RHD (odds ratio [OR] 1.47, 95% confidence interval [CI] 0.94 to 2.30, p = 0.089). However, RHD was associated with higher acute myocardial infarction (OR 1.65, 95% CI 1.07 to 2.56), acute kidney injury (OR 1.58, 95% CI 1.30 to 1.94), ventricular arrhythmia (OR 1.50, 95% CI 1.12 to 2.01), high-degree heart block (OR 1.67, 95% CI 1.25 to 2.23), and conversion to open surgical repair/replacement (OR 2.53, 95% CI 1.02 to 6.30). Mitral TEER in RHD was also associated with higher 90-day all-cause readmission (hazard ratio [HR] 1.19, 95% CI 1.04 to 1.47, p = 0.012). In conclusion, mitral TEER in patients with RHD is associated with higher rates of hospital complications, crossover to surgery, and readmissions but could be performed selectively in patients at high surgical risk who have favorable anatomy.

Sex-related differences in the trends and outcomes of trans-septal transcatheter mitral valve replacement: Insights from the National Readmissions Database

BACKGROUND

There is a paucity of data regarding the sex-related differences in the trends and outcomes of trans-septal transcatheter mitral valve replacement (TS-TMVR).

METHODS

The Nationwide Readmissions Database (2015-2018) was queried for admissions for TS-TMVR. Propensity matched analysis was conducted to compare outcomes with hospitalizations for TS-TMVR among women versus men. The main study outcome was in-hospital mortality.

RESULTS

Our final analysis included 2063 hospitalizations for TS-TMVR; of whom, 58.1% were women. The proportion of women among those undergoing TS-TMVR increased from 50% in 2015 to 60.2% in 2018 (P_trend  = 0.04). Compared with men, women undergoing TS-TMVR were slightly younger, and had a distinct profile of comorbidities. After matching, there was no significant difference in in-hospital mortality among women versus men undergoing TS-TMVR (7.8% vs. 6.1%, OR = 1.30; 95% CI: 0.79-2.13). Subgroup analyzes showed an interaction toward higher mortality with women versus men among patients with CKD (P_interaction  = 0.07). There were no significant differences between women and men in in-hospital complications or length of stay after TS-TMVR. Compared with men, women undergoing TS-TMVR were more likely to be discharged to a nursing facility (17.7% vs. 11.5%, p = 0.01) and had higher rates of 30-day readmissions (22.4% vs. 13.6%, p = 0.01).

CONCLUSION

This nationwide analysis showed an increase in the proportion of women among patients undergoing TS-TMVR during the study years. There were no differences in in-hospital mortality, in-hospital complications, or length of stay between both sexes following TS-TMVR. Women were more likely to be discharged to nursing facilities and had higher rates of readmission at 30 days even after propensity matching.