S2375 Do Cirrhotic Patients With Subsequent Heart Failure Benefit From Transcatheter Edge to Edge Mitral Valve Repair: A Global TriNetX Cohort

Introduction: Transcatheter Edge-to-Edge Repair of the Mitral Valve (M-TEER) is a novel treatment for mitral regurgitation (MR) which has been demonstrated to be safe and efficacious in high risk surgical patients. Patients with cirrhosis and heart failure (HF) who develop MR often have prohibitive surgical risk. This study seeks to elucidate the efficacy of M-TEER in this population. Methods: The TriNetX US Collaborative Network was used to query patients >18 with cirrhosis (n = 1,642,840). From this sample, 2 cohorts were created: those with cirrhosis followed by HF, MR, and M-TEER (n = 353) and those with cirrhosis followed by HF and MR, who did not receive mitral valve surgery or M-TEER (n = 32,093). Gender, race, diagnoses, and prior cardiac procedures were selected and subjected to propensity score matching (PSM). PSM was also performed on following covariates: age, sodium, creatinine, INR, and total bilirubin. At 12 months follow up, the following outcomes were assessed: all-cause mortality, major adverse cardiac events (MACE), myocardial infarction (MI), stroke, major bleeding, and blood transfusion. MACE was defined by the International Classification of Diseases, Tenth Revision codes for the following: acute MI, subsequent ST elevation and non ST elevation MI, nontraumatic subarachnoid hemorrhage, nontraumatic intracerebral hemorrhage, other and unspecified nontraumatic intracranial hemorrhage, cerebral infarction, and deceased. Results: After PSM analysis, 350 patients were present in each cohorts and there was no significant difference in odds ratio for the pre-specified outcomes. Interestingly, a Kaplan-Meier Analysis of all-cause mortality suggests a trend towards decreased mortality in the M-TEER group within the first few months post-procedurally, but does not reach significance: green line representing M-TEER cohort and purple line representing No Intervention cohort). Conclusion: Patients with cirrhosis who develop HF and MR do not appear to have any difference in mortality, cardiac endpoints, or hospitalization at 1 year following M-TEER, as compared to those with no intervention. Importantly, quality of life metrics and cardiac specific hospitalizations are not included in the analysis. Notably this study contrasts with recent large randomized studies investigating M-TEER. As such, the results should be taken with caution as the study is limited by its retrospective nature and reliance on coding.