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Published on: October 16, 2021
Clinical Outcomes and Cost Analysis in Patients with Heart Failure Undergoing Transcatheter Edge-to-Edge Repair for
Aleksander Dokollari1,2, Serge Sicouri1, Roberto Rodriguez3
1Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA.
Insights
Transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) in heart failure (HF) patients showed the worst outcomes in the mixed HF group. No significant differences in total hospital costs were observed across systolic, diastolic, and mixed HF groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Heart Failure Management
Background:
- Heart failure (HF) patients with mitral regurgitation (MR) often present complex clinical profiles.
- Transcatheter edge-to-edge repair (TEER) is an established treatment for MR, but outcomes may vary based on HF type.
- Understanding differential outcomes in systolic, diastolic, and mixed HF is crucial for optimizing TEER patient selection.
Purpose of the Study:
- To compare the clinical and cost outcomes of TEER for MR in patients with systolic, diastolic, and mixed HF.
- To identify specific patient groups that may experience suboptimal results post-TEER.
- To inform clinical decision-making and resource allocation for HF patients undergoing TEER.
Main Methods:
- A propensity-adjusted analysis of 162 HF patients undergoing TEER for MR (January 2019-March 2023).
- Patients were categorized into systolic, diastolic, or mixed HF based on AHA guidelines.
- Primary outcomes included long-term all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs).
Main Results:
- The mixed HF group experienced higher rates of all-cause death, MACCEs, and pacemaker implantations compared to systolic and diastolic groups.
- Postoperative outcomes showed differences, with the diastolic HF group having longer ICU stays and lower ejection fraction compared to systolic HF.
- No significant differences in total hospital costs were found among the three HF subgroups.
Conclusions:
- TEER for MR is associated with the poorest postoperative and follow-up clinical outcomes in patients with mixed HF.
- Diastolic HF patients demonstrated distinct postoperative recovery patterns compared to systolic HF patients.
- TEER appears to be a cost-neutral intervention across different HF etiologies, despite varying clinical outcomes.
Abstract:
Objective: To analyze the clinical and cost outcomes of transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) in heart failure (HF) patients. Methods: All 162 HF patients undergoing TEER for MR between January 2019 and March 2023 were included. A propensity-adjusted analysis was used to compare 32 systolic vs. 97 diastolic vs. 33 mixed (systolic + diastolic) HF patients. Systolic, diastolic, and mixed HF patients were defined according to AHA guidelines. The primary outcome was the long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs, all-cause mortality + stroke + myocardial infarction + repeat intervention). Results: The mean age was 76.3 vs. 80.9 vs. 76 years old, and the mean ejection fraction (EF) was 39.5% vs. 59.8% vs. 39.7% in systolic vs. diastolic vs. mixed HF, respectively. Postoperatively, the diastolic vs. systolic HF group had a higher intensive care unit stay (21 vs. 0 h; HR 67.5 (23.7, 111.4)]; lower ventilation time [2 vs. 2.3 h; HR 49.4 (8.6, 90.2)]; lower EF [38% vs. 58.5%; HR 9.9 (3.7, 16.1)]. In addition, the diastolic vs. mixed HF groups had a lower incidence of EF < 50% (11 vs. 27 patients; HR 6.6 (1.6, 27.3) and a lower use of dialysis (one vs. three patients; HR 18.1 (1.1, 287.3), respectively. At a mean 1.6 years follow-up, all-cause death [HR 39.8 (26.2, 60.5)], MACCEs [HR 50.3 (33.7-75.1)], and new pacemaker implantations [HR 17.3 (8.7, 34.6)] were higher in the mixed group. There was no significant total hospital cost difference among the systolic (USD 106,859) vs. diastolic (USD 91,731) vs. mixed (USD 120,522) HF groups (p = 0.08). Conclusions: TEER for MR evidenced the worst postoperative and follow-up clinical outcomes in the mixed HF group compared to diastolic and systolic HF groups. No total hospital cost differences were observed.
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