Abstract 4143119: National Inpatient Mortality Trend of Mitral Valve Transcatheter Edge-to-Edge Repair in Patients With End-Stage Renal Disease on Dialysis

Background: Mitral valve transcatheter edge-to-edge repair (M-TEER) is performed for high-risk patients with severe mitral regurgitation and multiple comorbidities. End-stage renal disease (ESRD) is one poor prognostic factor in M-TEER. However, real-life, large-scale data on inpatient mortality in ESRD patients undergoing M-TEER are lacking. Methods: The National Inpatient Sample from Jan 2015 to Dec 2020 was used to identify the study cohort using the International Classification of Diseases, 9th&10 th Revisions, Clinical Modificatio n. The primary outcome was overall in-hospital mortality for patients with and without ESRD undergoing M-TEER. The secondary outcome was inpatient mortality trends in these groups. Univariate and multivariate logistic regressions (adjustment for age, race, Elixhauser comorbidity index score) were used. Results: We evaluated 44,845 patients who underwent M-TEER, of whom 2135 (4.7%) had ESRD on dialysis. The ESRD group was younger than the non-ESRD group (69.9 vs 76.4 years, P<.001), with a similar percentage of females (41.9% vs 45.4%, P=.151). Total procedure number increased significantly from 3184 to 11680 during the study period (Fig 1A). Overall mortality was significantly higher in ESRD patients (11.7% vs 1.5%, P<.001). Adjusted mortality in the ESRD group increased from 2.2% in 2015 to 12.9% in 2020 (P=.025), whereas the mortality rate remained relatively stable in non-ESRD patients (2.1% to 1.5%, P=.150) (Fig 1B). The ESRD group was associated with a higher incidence of immediate postoperative complications, which may have contributed to higher mortality (Table). Conclusion: Patients with ESRD on dialysis undergoing M-TEER had significantly higher mortality rates than non-ESRD patients. Despite younger age, mortality for ESRD patients rose substantially; it remained relatively stable for non-ESRD patients. These findings highlight the elevated risk and need for tailored management strategies for ESRD patients undergoing M-TEER.