NCDR Registry Data Provides Insights on MitraClip Outcomes in U.S.

Data from the NCDR STS/ACC TVT Registry revealed a high rate of acute procedural success with the MitraClip system for transcatheter mitral valve (MV) repair, according to results presented by Paul Sorajja, MD, FACC, on March 18 at ACC.17 in Washington, DC.

In 2,952 patients examined for the acute outcome, 92.8 percent had post-procedural mitral regurgitation of ≤2. In-hospital mortality was 2.7 percent, and most patients were discharged home (85.9 percent) after a median two-day hospitalization. The median age of the patients was 82 years, 56 percent were men, 85 percent had NYHA Class III/IV heart failure and 93 percent had Grade III/IV mitral regurgitation.

The study investigators analyzed data in patients enrolled in the TVT Registry between December 2012 and September 2015. To evaluate longer term outcomes in these patients, they examined Centers for Medicare and Medicaid Services claims data in 1,867 of these patients.

At one year, 25.9 percent of patients had died, 20.2 percent were re-hospitalized for heart failure and 37.9 percent had experienced either event. A repeat MitraClip procedure was required in 6.2 percent and 2.1 percent required MV surgery.
Patients with functional MR, compared with degenerative MR, had a higher rate of death (31.2 percent vs 24.7 percent; p = 0.028) and death plus hospitalization (49.0 percent vs 35.7 percent; p = 0.002). The rates of severe, moderate and mild/no tricuspid regurgitation were 38.5 percent, 23.5 percent and 23.4 percent, respectively.

The lower the grade of regurgitation, the lower the rate of death. For Grade 0/1, mortality was 21.7 percent, for Grade II it was 29.2 percent, and for Grade III/IV it was 48.9 percent.

Of note, the one-year outcomes revealed variation in relation to baseline characteristics. Clinical variables that were significant and predicted one-year outcomes were age (per five years), dialysis, moderate-severe lung disease, left ventricular ejection fraction (per 5 percent), severe tricuspid regurgitation and residual mitral regurgitation.

Keywords: ACC17, ACC Annual Scientific Session, Heart Failure, Heart Valve Diseases, Hospitalization, Medicaid, Mitral Valve, Mitral Valve Insufficiency, Morbidity, Registries, Stroke, Thoracic Surgery, Thoracic Surgical Procedures

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