Transcatheter edge-to-edge repair (TEER) with MitraClip (Abbott, Santa Clara, California)
is a frequently chosen method for mitral valve repair for patients at high surgical
risk. We investigated the impact of frailty on outcomes of patients who underwent
TEER. We reviewed the National Inpatient Sample to identify patients that underwent
TEER with MitraClip. Frailty was defined using the Johns Hopkins Adjusted Clinical
Groups frailty-defining diagnoses indicator. The primary end point was in-hospital
mortality. The secondary end points included blood transfusion, respiratory failure,
sepsis, length of stay, and total hospitalization cost. Univariate and multivariate
logistic regression analyses were performed to determine any association between frailty
and primary or secondary outcomes. From January 2016 to December 2017, 10,055 patients
underwent TEER in the United States, and 10.6% of them met the criteria for frailty.
The frail group showed increased in-hospital mortality (7.04% vs 1.61%, p <0.001)
and respiratory failure (3.75% vs 0.95%, p <0.001). Similarly, the frail group had
longer lengths of stay (6 vs 2 days, p <0.001) and higher hospitalization costs ($224.8k
vs $180.9k, p <0.001). After multivariable logistic regression analysis, frailty was
associated with increased in-hospital mortality (odds ratio [OR] 3.70, 95% confidence
interval [CI] 1.91 to 7.18, p <0.001), transfusion (OR 1.85, 95% CI 1.07 to 3.19,
p = 0.029), respiratory failure (OR 3.56, 95% CI 1.48 to 8.52, p = 0.005), and sepsis
(OR 4.17, 95% CI 1.84 to 9.46, p = 0.001).
In conclusion, frailty was present in about 10% of patients who underwent TEER from
2016 to 2017. The presence of frailty was associated with worse in-hospital outcomes
and greater resource use.