Two studies analyzing data from the STS/ACC TVT Registry exploring out-of-hospital 30-day mortality after mitral transcatheter edge-to-edge repair (TEER) and one-year cause-specific mortality after TAVR were published in JACC: Cardiovascular Interventions on March 19.

In the study evaluating patients undergoing mitral TEER, Kannu Bansal, MBBS, et al., found that while the overall rate of 30-day mortality post procedure was low, two out of every five deaths occurred out-of-hospital.

The authors included 61,139 patients undergoing mitral TEER at 539 sites across the U.S. between January 2014 and April 2023. The study's primary outcome was out-of-hospital all-cause mortality at 30 days post procedure. A secondary outcome of interest was out-of-hospital cardiovascular mortality at 30 days.

Of the 1,813 patients who died within 30 days post procedure, 744 (41%) died out-of-hospital after discharge, and 63.4% of the out-of-hospital 30-day deaths were due to cardiovascular causes.

The authors note several baseline and procedural factors independently associated with out-of-hospital 30-day mortality, including "older age, White race, non-Hispanic ethnicity, lower baseline hemoglobin, poor baseline health status, presentation as [NSTEMI], lower [LVEF], higher acuity presentation, in-hospital complications, ≥moderate residual mitral regurgitation, and lack of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge."

"Future efforts should focus on improving patient selection, reducing procedural complications, and optimizing [guideline-directed medical therapy (GDMT)] and post-discharge care to improve outcomes in this vulnerable population," write the authors.

In an accompanying editorial comment, Vera Fortmeier, MD, and Tanja K. Rudolph, MD, emphasize the importance of adequate patient selection and utilization of guideline-directed medical therapy post discharge. "Notably, death remains unpredictable to a certain degree, particularly in older and more complex patients," they add. "This underscores the importance of optimizing every modifiable factor to prolong life and enhance the well-being of patients undergoing [mitral TEER]."

An additional study looking at trends in one-year cause-specific mortality post TAVR by Dhaval Kolte, MD, PhD, MPH, et al., found that noncardiac causes were responsible for two-thirds of deaths at one-year following TAVR, and identified an increase in risk of cardiac and noncardiac death from 2018 to 2022.

Overall, 36,877 patients from the registry died within one year post TAVR and had available information on cause of death between January 2012 and October 2022.

Results showed that 31.3% of deaths were from cardiac causes while 68.7% were noncardiac in nature. Investigators note the most common noncardiac causes of death "were pulmonary, infectious, and neurologic (including stroke)," highlighting "the need for appropriate multidisciplinary care to manage noncardiac comorbidities before and after TAVR.

Over the course of the study period, authors describe an initial decline in risk of cardiac and noncardiac death at one year post TAVR from 2012 to 2017 (adjusted hazard ratio [HR] per year: 0.95 and 0.92, respectively); however, from 2018 to 2022, risk of cardiac and noncardiac death increased (adjusted HR per year: 1.07 and 1.22, respectively).

The authors acknowledge the need for future studies "to understand the impact of the COVID-19 pandemic on TAVR outcomes at the patient and hospital levels in the [U.S.], as well as to monitor trends in all-cause and cause-specific mortality after TAVR in the postpandemic era."

Joaquin Cigarroa, MD, FACC, and Steven R. Bailey, MD, FACC, write in an accompanying editorial comment that "this report serves as a call to action to address the noncardiac causes of death identified here and in other publications... Implementing a multidisciplinary team that evaluates high-risk patients, focusing on changes in clinical status with early recognition and treatment, will be a lifeline that decreases hospitalization and late clinical events."

Citations

• Bansal K, Rawlley B, Majmundar V, et al. Out-of-hospital 30-day mortality after mitral TEER. JACC: Cardiovascular Interventions. Published online on March 19, 2025. doi:10.1016/j.jcin.2025.01.425
• Kolte D, Marquis-Gravel G, Stebbins A, et al. Temporal trends in 1-year cause-specific mortality after TAVR. JACC: Cardiovascular Interventions. Published online on March 19, 2025. doi:10.1016/j.jcin.2024.12.016