The following is a summary of “Impact of Transcatheter Mitral Valve Repair Availability on Volume and Outcomes of Surgical Repair,” published in the February 2023 issue of Cardiology by Lowenstern, et al.
How transcatheter edge-to-edge repair (TEER) affected the quantity and effectiveness of surgical mitral valve repairs (MVr) nationwide was unknown. For a study, researchers evaluate the effects of TEER availability on the volumes and results of MVr in degenerative mitral regurgitation.
MVr volume, 30-day and 5-year outcomes, such as mortality, heart failure rehospitalization, and mitral valve reintervention, were compared within TEER centers before and after the first institutional TEER procedure using data from the Society of Thoracic Surgeons database linked with Medicare administrative claims. To account for historical advancements in perioperative care, parallel trends in coronary artery bypass grafting outcomes were compared using a difference-in-difference technique.
About 13,959 patients underwent MVr at 278 institutions between July 2011 and December 2018, during which TEER capability was added. Before (32 [IQR: 17-54]) and after (29 [IQR: 16-54]) the first TEER (P = 0.06), there was no discernible difference in the median annualized institutional MVr volume. Nevertheless, lower-risk MVr surgeries (Society of Thoracic Surgeons projected risk of death ≥2%) decreased during the research period (P< 0.001 for trend). At 30 days (adjusted OR: 0.73; 95% CI: 0.54-0.99) and over 5 years (adjusted HR: 0.75; 95% CI: 0.66-0.86), TEER was linked to lower risk-adjusted odds of mortality after MVr. The 30-day and 5-year death rates reductions were noticeably higher than comparable trends in coronary artery bypass grafting.
The introduction of TEER was related to a decline in higher-risk surgical procedures and improved 30-day and 5-year outcomes among institutions implementing the technology, but it had not appreciably impacted overall MVr case volumes for degenerative mitral regurgitation.
Reference: jacc.org/doi/10.1016/j.jacc.2022.11.043
