Assessing the Impact of Urgency and Delays to Transcatheter Edge-to-Edge Repair in a New Regional Program

The impact of acuity in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) treatment remains unclear.

This study examined outcome differences between elective versus urgent TEER cohorts, as well as identifying existence of referral delays to a new regional TEER program.

Consecutive patients undergoing TEER between 2021 and 2023 in the Fraser Health Authority were identified. Outcomes were compared between patients having elective versus urgent TEER. The co-primary outcomes were 1 year mortality and heart failure (HF) readmission. Logistic regression was performed to determine associations between urgency and 1 year outcomes.

A total of 52 patients underwent TEER over 2 years. Twenty-one (40%) had urgent procedures. Urgent TEER patients more frequently had baseline NYHA IV status and higher STS-mortality scores. Both 1 year mortality (Urgent 38.1% vs. Elective 6.7%, p = 0.01) and HF readmission (Urgent 47.6% vs. Elective 12.9%, p < 0.01) rates were significantly higher in the urgent cohort. Procedural urgency was the only independent predictor of 1 year mortality (OR 20.83, 95% CI 1.27-341.56) and HF readmission (OR 13.56, 95% CI 1.98-92.81). Amongst urgent patients, a median delay of 97 days (IQR 16,307) from significant MR diagnosis to TEER referral was noted, despite > 80% specialist involvement. During delays, 14 (67%) patients had ≥ 1 pre-TEER HF admission.

In a new regional program, urgent TEER was associated with increased 1 year mortality and HF readmissions. Preprocedural HF admissions were common with delayed TEER referral, suggesting further study to determine whether referral expediency can lessen patient acuity and improve outcomes.