Predicting the Need for Intensive Care Unit Treatment After Successful Transcatheter Edge-to-Edge Mitral Valve Repair

<b>Background/Objectives:</b> Transcatheter edge-to-edge mitral valve repair (M-TEER) has emerged as an efficacious treatment modality among patients at high perioperative risk. Given the steady increase in procedures and the limited capacity for intensive care, there is a need to identify patients at high risk for postinterventional intensive care. <b>Methods:</b> All patients who underwent M-TEER between 2014 and 2023 were investigated. The intensive care unit (ICU) stay ended when patients met all the following criteria: no further need for catecholamine support, no oxygen requirement > 6 L O2/min, no indication for renal replacement therapy, and no delirium or relevant bleeding. Uni- and multivariable logistic regression analyses were used to identify independent predictors of the need for ICU treatment. <b>Results:</b> In total, 33% of patients (62/183) had an indication for ICU treatment after M-TEER. Patients with an indication for ICU treatment had significantly lower survival rates three years after M-TEER (37.4% [23/62] vs. 61.6% [75/121], <i>p</i> < 0.001) than patients without an ICU indication. A EuroSCORE II of >10% (OR 2.6, 95% CI 1.3-5.4, <i>p</i> = 0.006), a MitraScore of >3 (OR 2.5, 95% CI 1.2-5.2, <i>p</i> = 0.02), and a hospital stay of >5 days before M-TEER (OR 3.2, 95% CI 1.6-6.4, <i>p</i> < 0.001) were independently associated with the need for ICU treatment. <b>Conclusions:</b> One-third of the patients were indicated for ICU treatment, which was associated with a high mortality rate. On the basis of these predictors of required ICU care, tailored treatment strategies can be developed to improve treatment outcomes.