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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Outcomes of Mitral Transcatheter Edge-to-Edge Repair in Patients With Rheumatic Heart Disease
Mohammed Elzeneini1, Hassan Ashraf2, Ahmad Mahmoud1
1Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
The American Journal of Cardiology
|February 22, 2023
Summary
Transcatheter edge-to-edge repair (TEER) for rheumatic mitral regurgitation shows similar in-hospital mortality but increased complications and readmissions. This procedure may be selectively used in high-risk patients with favorable anatomy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Rheumatic heart disease (RHD) causes mitral regurgitation, often leading to leaflet thickening and calcification, making transcatheter edge-to-edge repair (TEER) challenging.
- Limited data exist on the safety and efficacy of TEER in patients with severe symptomatic rheumatic mitral regurgitation.
Purpose of the Study:
- To investigate the safety and efficacy of mitral TEER in patients with severe symptomatic rheumatic mitral regurgitation.
- To evaluate the association of RHD with in-hospital outcomes and 90-day readmissions after mitral TEER.
Main Methods:
- Analysis of Nationwide Readmissions Database for mitral TEER hospitalizations between 2016 and 2018.
- Propensity score-weighted regression analysis to assess RHD's impact on outcomes.
- Inclusion of 18,240 procedures, with 1,779 in RHD patients.
Main Results:
- Mitral TEER in RHD patients had similar in-hospital mortality compared to non-RHD patients (OR 1.47, p=0.089).
- RHD was associated with increased acute myocardial infarction, acute kidney injury, ventricular arrhythmia, high-degree heart block, and conversion to open surgery.
- Mitral TEER in RHD patients showed higher 90-day all-cause readmission rates (HR 1.19, p=0.012).
Conclusions:
- Mitral TEER in RHD patients is linked to higher hospital complications, surgical crossover, and readmissions.
- The procedure may be selectively considered for high-risk surgical patients with favorable mitral valve anatomy.
- Further research is needed to optimize TEER outcomes in the RHD population.
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