Out-of-Hospital 30-Day Mortality After Mitral TEER: Insights From the STS/ACC TVT Registry

Background: Transcatheter edge-to-edge repair of mitral valve (mTEER) is increasingly being adopted, with improved outcomes. However, it remains crucial to evaluate short-term out-of-hospital mortality to elucidate areas for further improvement. Objectives: The authors sought to evaluate incidence and predictors of out-of-hospital 30-day mortality after mTEER. Methods: We used the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry to identify patients who underwent mTEER between January 2014 and April 2023. Primary and secondary outcomes were 30-day out-of-hospital all-cause and cardiovascular mortality, respectively. Logistic regression and survival analysis models were used to identify factors associated with these outcomes. Results: Of 61,139 patients who underwent mTEER, 1,813 (3.0%) died within 30 days of the procedure. Of these, 744 (41.0%) died out-of-hospital after discharge. Cardiovascular causes accounted for 63.4% of out-of-hospital mortality at 30 days. The median time from discharge to 30-day out-of-hospital all-cause mortality was 11 (Q1-Q3: 5-19) days. Older age, White race, non-Hispanic ethnicity, lower baseline hemoglobin, poor baseline health status, presentation as non–ST-segment elevation myocardial infarction, lower left ventricular ejection fraction, higher acuity presentation, in-hospital complications, ≥moderate residual mitral regurgitation, and lack of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge were independently associated with higher 30-day out-of-hospital all-cause and cardiovascular mortality. Conclusions: Although overall 30-day all-cause mortality after mTEER was low, 2 of 5 deaths occurred out-of-hospital after discharge. Multiple modifiable factors such as patient selection, guideline-directed medical therapy underutilization and procedural complications require optimization to mitigate out-of-hospital mortality after mTEER.