National Trends in Mitral Valve Surgery Outcomes in Centers with and Without Transcatheter Edge-to-Edge Repair

S. Roberts Pyeatte¹, C. Jones², M. Braasch³, T. Marghitu³, K. Stumbaugh³, J. He⁴, A. Brescia⁵, N. Kouchoukos⁶, T. Kaneko^3
1Washington University School of Medicine in St Louis, St. Louis, Missouri ²Washington University in St. Louis, St Louis, Missouri ³Washington University in St. Louis, St. Louis, Missouri ⁴Washington University at Saint Louis, st louis, Missouri ⁵University of Michigan, Ypsilanti, Michigan ⁶Washington University in St. LouisNone, St. Louis, Missouri

Purpose: At the institutional level, introduction of transcatheter edge-to-edge repair (TEER) is associated with improved mortality in patients undergoing mitral valve repair. We aimed to evaluate mitral valve surgery (MVS) outcomes based on center availability of TEER on a national scale. We hypothesized centers providing TEER would have improved MVS outcomes.

Methods: The National Readmissions Database was utilized to review patients age >18 years who underwent MVS at centers with and without TEER from 2016-2020. Patients with a history of endocarditis or prosthetic valve dysfunction were excluded. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included annual MVS volume, 30-day readmission, hospital length of stay, and post-procedural complications. Multivariate logistic regression analysis was conducted, adjusting for multiple patient variables, to determine the effects of TEER availability on operative outcomes. Annual center MVS volume was stratified into tertiles to classify centers as low, intermediate, or high volume. Sensitivity analyses were performed evaluating 30-day mortality for mitral valve repair (MVr) only and mitral valve replacement (MVR) only.

Results: Of the 50,179 patients who underwent MVS from 2016-2020, 15,485 underwent MVS at a non-TEER hospital and 34,694 underwent MVS at a TEER hospital. During this period, the number of centers with TEER significantly increased from 2,539 in 2016 to 6,326 in 2020 (p < 0.05). The annual volume of TEER procedures performed significantly increased, while there was no significant change in the annual volume of MVS. Patients at non-TEER hospitals tended to be older, male, with higher rates of comorbidities and prior PCI and CABG (Table, all P< 0.05). 30-day mortality after MVS was significantly higher in patients at non-TEER centers than in patients at TEER centers (6.7% vs. 5.0%, P< 0.001). Rates of pacemaker placement after MVS were significantly lower at non-TEER centers (14.2% vs. 17.5%, P< 0.001). On multivariate analysis, non-TEER hospital status was independently predictive of 30-day mortality (OR1.21, 95%CI[1.09, 1.33], P< 0.001). Age, female sex, diabetes, PVD, kidney disease, and low or intermediate MVS center volume were also associated with 30-day mortality (all P< 0.001, Figure). When MVr and MVR were analyzed independently, 30-day mortality was also higher at non-TEER centers after MVr (4.3% vs. 2.1%, P< 0.001) and MVR (4.25% vs. 2.1%, P< 0.001).

Conclusion: Centers with TEER have significantly lower 30-day mortality after MVS than centers without TEER, even after adjustment by MVS volume. This study supports the concept of Center of Excellence in MVS (both MVr/MVR), including the availability of TEER.

Identify the source of the funding for this research project: This project did not receiving funding support.