Two year outcome in nonagenarians undergoing percutaneous mitral valve repair

Christidi, Aikaterini; Haschemi, Jafer; Spieker, Maximilian; Kelm, Malte; Westenfeld, Ralf; Horn, Patrick

doi:10.1002/ehf2.13127

Cited by 9 publications

(1 citation statement)

References 25 publications

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“…In addition, compared with medical therapy alone, M-TEER resulted in a lower rate of hospitalisation due to heart failure within 24 months of follow-up [ 4 ]. We previously demonstrated that the beneficial long-term effects of M-TEER in nonagenarians were comparable to those in younger patients [ 9 ]. These clinical benefits for patients might reduce the costs of healthcare systems.…”

Section: Discussionmentioning

confidence: 99%

Comparison of costs associated with transcatheter mitral valve repair: PASCAL vs MitraClip in a real-world setting

Haurand,

Haschemi,

Oehler

et al. 2023

BMC Health Serv Res

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Aims We aimed to conduct a clinical process cost analysis to evaluate all upcoming costs of mitral valve transcatheter edge-to-edge repair (M-TEER) treatment using the MitraClip and the PASCAL repair system. Methods First, we prospectively enrolled 107 M-TEER patients treated with either the PASCAL or MitraClip system and compared all upcoming costs during the M-TEER procedure and the associated in-hospital stay. Second, we retrospectively analysed 716 M-TEER procedures with regard to the occurrence of complications and their associated costs. All materials used in the catheterization laboratory for the procedures were evaluated. The cost analysis considered various expenses, such as general in-hospital costs, device costs, catheter laboratory and material costs. Results In the prospective study, 51 patients were treated using the PASCAL system, and 56 were treated using the MitraClip system. The two groups had comparable baseline characteristics and comorbidities. The total in-hospital costs were 25 414 (Interquartile range (IQR) 24 631, 27 697) € in the PASCAL group and 25 633 (IQR 24 752, 28 256) € in the MitraClip group (p = 0.515). The major cost driver was initial material expenditure, mostly triggered by device costs, which were similar to the PASCAL and MitraClip systems. Overall intensive care unit and general ward costs did not differ between the PASCAL and MitraClip groups. In the retrospective analysis, M-TEER-related complications were rare but were associated with higher costs, mainly due to prolonged hospitalisation. Conclusion The major cost driver of M-TEER was the material expenditure, which was mostly triggered by high device costs. The costs of treating patients were similar for the PASCAL and MitraClip systems. M-TEER-related complications are associated with higher costs, mainly due to prolonged hospitalisation. This analysis provides valuable insights into reducing expenses by modifying the process of M-TEER.

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Section: Discussionmentioning

confidence: 99%

Comparison of costs associated with transcatheter mitral valve repair: PASCAL vs MitraClip in a real-world setting

Haurand,

Haschemi,

Oehler

et al. 2023

BMC Health Serv Res

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The Clinical Impact of Mitral Gradient Post Transcatheter Edge‐To‐Edge Repair: A Systematic Review and Meta‐Analysis

Alabdaljabar,

Almiro,

Khan

et al. 2024

Cathet Cardio Intervent

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BackgroundMitral transcatheter edge‐to‐edge repair (TEER) is a minimally invasive therapy for severe mitral regurgitation (MR) in patients with high surgical risk. TEER results in a tissue bridge that decreases mitral valve area, potentially leading to elevated mean gradient. The clinical impact of elevated gradient on outcomes is unclear.MethodsThis systematic review and meta‐analysis was based on a comprehensive search of five databases. We included studies that evaluated post mitral TEER gradient on one of the following outcomes: all‐cause mortality, combined endpoints, symptoms, hospitalizations, and mitral valve re‐intervention. Meta‐analysis was conducted using the random‐effects model.ResultsOut of 6458 citations, 17 studies were included (2017−2024) reporting on 7748 patients. There was significant heterogeneity between studies related to the cutoff used to define elevated gradient, etiology of MR, and outcomes. Elevated mitral gradient post TEER (4, 4.5, 5 mmHg) was associated with worse combined endpoint (HR = 1.35, 95% CI 1.07−1.71; I2 64%), but not all‐cause mortality (HR = 1.25, 95% CI 0.97−1.59; I2 45%) or risk of hospitalization. For the combined endpoint, this association was mainly significant in patients who had mitral gradient assessed using discharge echocardiogram (HR = 1.39, 95% CI 1.07−1.81; I2 62%) for all patients and for those with degenerative MR.ConclusionDespite the heterogeneity between studies, the current analysis suggests that patients with elevated mitral gradient post TEER are at risk of worse clinical outcomes, particularly in patients who had mitral gradient assessed using discharge transthoracic echocardiogram.

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Two year outcome in nonagenarians undergoing percutaneous mitral valve repair

et al. 2020

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Aims Percutaneous mitral valve repair (PMVR) has emerged as standard treatment in selected patients with clinically relevant mitral regurgitation (MR) and increased surgical risk. We aimed to evaluate the safety and clinical outcomes in nonagenarians undergoing PMVR. Methods and results Altogether, 493 patients with severe MR who were treated with PMVR were included in this open-label prospective study and followed up for 2 years. We treated 25 patients with PMVR aged 90 years or above, 185 patients aged 80-89 years, and 283 patients aged <80 years. PMVR in nonagenarians was safe and did not differ from PMVR in younger patients in terms of safety endpoints. Device success did not differ among the groups (100% in nonagenarians, 95.7% in octogenarians, and 95.1% in septuagenarians, P = 0.100). Unadjusted 2 year mortality was 28% in nonagenarians, 32.4% in octogenarians, and 19.8% in septuagenarians (P = 0.008). Kaplan-Meier curves confirmed similar 2 year survival in the nonagenarian and octogenarian groups (P = 0.657). In the multivariate analysis, age [hazard ratio (HR) 1.031, 95% confidence interval (CI) 1.002-1.060, P = 0.034], higher post-procedural transmitral valve gradients (HR 1.187, 95% CI 1.104-1.277, P = 0.001), and post-procedural acute kidney injury (HR 2.360, 95% CI 1.431-3.893, P = 0.001) were independent predictors of 2 year mortality. Altogether, 89.4% of the nonagenarians, 85.9% of the octogenarians, and 86.4% of the septuagenarians had MR grade of 2+ or less at 1 year after PMVR (P = 0.910). New York Heart Association functional class improved in the vast majority of patients, irrespective of age (P = 0.129). After 1 year, 9.5% of the nonagenarians, 22.3% of the octogenarians, and 25.2% of the septuagenarians (each P = 0.001 compared with baseline) suffered from New York Heart Association Functional Class III or IV. The rate of heart failure rehospitalization in the first 12 months after PMVR did not differ among the groups (16% in the nonagenarians, 16.7% in the octogenarians, and 17.7% in the septuagenarians) (P = 0.954). Quality of life assessed by the Minnesota Living with Heart Failure Questionnaire before and at 1 year after PMVR improved in all age groups (P = 0.001). Conclusions Percutaneous mitral valve repair in carefully selected nonagenarians is feasible and safe with intermediate-term beneficial effects comparable with those in younger patients.

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Two year outcome in nonagenarians undergoing percutaneous mitral valve repair

Cited by 9 publications

References 25 publications

Comparison of costs associated with transcatheter mitral valve repair: PASCAL vs MitraClip in a real-world setting

Comparison of costs associated with transcatheter mitral valve repair: PASCAL vs MitraClip in a real-world setting

The Clinical Impact of Mitral Gradient Post Transcatheter Edge‐To‐Edge Repair: A Systematic Review and Meta‐Analysis

Two year outcome in nonagenarians undergoing percutaneous mitral valve repair

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