In 2013, the Food and Drug Administration approved the first transcatheter mitral valve repair (TMVr) device for degenerative mitral regurgitation for patients at prohibitive surgical risk. To better understand contemporary utilization trends and outcomes, we reviewed hospitalizations, identified using International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes, in which the patient underwent TMVr or mitral valve repair (MVr) with a diagnosis of mitral regurgitation, without stenosis, from the National (Nationwide) Inpatient Sample from 2014 to 2017. We included 10,020 hospitalizations in which the patient underwent TMVr and 5845 in which the patient underwent MVr and assessed trends in demographic characteristics, patient comorbidities, total hospital charges, and outcomes. Transcatheter mitral valve repair experienced exponential growth, increasing from 150 to 5115 over the study period (Pc.001 for trend), whereas MVr grew to a lesser degree. The median length of stay for TMVr decreased from 4 to 2 days; mortality declined from 3.3% to 1.6% (P<.001 for both). Both TMVr and MVr rates of discharge home increased over the study period. Total charges for TMVr increased from $149,582 to $178,109, whereas those for MVr increased to a lesser degree, from $149,426 to $157,146 (P<.001 for both). Discharge disposition, length of stay, and in-hospital mortality all exhibited favorable trends for both procedures. Caution must be exercised in direct comparisons between procedures as they target somewhat different populations. With expanded indications for TMVr, we anticipate further increases in procedural volume, although the effect on MVr remains unclear.
Severe mitral regurgitation (MR) is associated with considerable morbidity and mortality, with up to 34% annual mortality with medical management. (1) Until the adoption of percutaneous mitral valve interventions, surgical mitral valve repair (MVr) or replacement were the only available approved interventions for severe MR. In 2011, the Endovascular Valve Edge-to-Edge Repair Study II studied transcatheter mitral valve repair (TMVr) compared with open surgical intervention (repair or replacement) for patients with 3+ or 44- (moderate-to-severe or severe) MR due to primary (degenerative) mitral valve disease. The Endovascular Valve Edge-to-Edge Repair Study II reported noninferiority of TMVr in terms of the primary end point: a composite of freedom from death, surgery for mitral valve dysfunction, or grade 34- or 44- MR. (2) Subsequent follow-up studies found improved quality of life in patients undergoing TMVr. (3) This led to the Food and Drug Administration's (FDA's) approval of the first device in 2013 for patients at prohibitive surgical risk for MVr as well as guideline updates to include its use. (4) Further studies and meta-analyses have revealed similar findings of noninferiority of TMVr vs mitral valve surgery. (5) We sought to analyze trends in the adoption of TMVr relative to MVr as well as outcomes since 2014, the first full year since FDA approval.
PATIENTS AND METHODS Data Source
We analyzed hospitalizations in which patients underwent TMVr or MVr from 2014 to 2017 using the National (Nationwide) Inpatient Sample (NIS), (6) which contains weighted data for more than 35 million annual hospitalizations nationally....