Feasibility of Transcatheter Edge to Edge Repair in Hypertrophic Obstructive Cardiomyopathy

Author Type(s)

Faculty, Resident/Fellow

Document Type

Abstract

Publication Date

3-2023

Journal Title

Journal of the American College of Cardiology

Department

Medicine

Abstract

Background

Transcatheter edge-to-edge repair (TEER) of the mitral valve was approved for patients with secondary mitral regurgitation (MR). Systolic anterior motion (SAM) of anterior mitral valve leaflet in patients with hypertrophic cardiomyopathy (HCM) is responsible for secondary MR. There are some case reports and case series illustrating the feasibility of TEER in patients with HCM to reduce the MR and, thereby, left-ventricular outflow tract (LVOT) obstruction. However, there is no large-scale study to demonstrate the outcomes of TEER in patients with HCM.

Methods

We used National Inpatient Sample from 2014-19 to include all admissions where TEER was performed using the ICD-10-CM/PCS. Then we compared TEER patients who had preexisting HCM vs. those who did not have HCM. The primary outcome of interest was in-hospital mortality. Secondary outcomes were the development of cardiogenic, acute kidney injury (AKI), ventilator use, vasopressor use, and use of mechanical support devices.

Results

Amongst 32300 TEER admissions, 115 patients had concomitant HCM. The mean age and duration of the hospital stay were similar in both groups. There was a higher proportion of females in the HCM group. The distribution of comorbidities, including AF, HTN, DM, CKD, COPD, coronary artery disease, history of revascularization, and peripheral vascular disease, was not significantly different in both groups. There was an increase in the number of TEER procedures in patients with HCM in 2018-2019. In-hospital mortality was significantly higher in HCM patients [8.7% vs. 2%, P=0.024; aOR: 5.06, 95% CI: 1.25-20.4; P=0.03]. There was no significant difference between the two groups in terms of cardiogenic shock, AKI, use of a mechanical ventilator, use of vasopressor, or mechanical support devices.

Conclusion

We have noticed higher in-hospital mortality in patients who are undergoing TEER with concomitant HCM compared to the patients who did not have HCM. However, other in-hospital complications were not statistically significant between both groups. We need further randomized controlled trials to demonstrate the impact of preexisting HCM in patients undergoing TEER procedures for secondary MR.

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