Impact of the introduction of percutaneous edge-to-edge mitral valve reconstruction on clinical practice in Germany compared to surgical valve repair.
BACKGROUND
The introduction of percutaneous mitral valve (MV) repair had an effect on clinical practice in comparison with surgical MV repair. Complete nationwide data are useful in examining how the introduction of a new technique influences clinical practice.


METHODS
We analyzed procedural numbers, patient characteristics, and in-hospital outcomes for all percutaneous edge-to-edge and surgical MV reconstruction procedures performed in Germany between 2009 and 2015.


RESULTS
12,664 percutaneous edge-to-edge and 22,825 surgical MV reconstructions were recorded. Numbers increased steadily, albeit more rapidly in the percutaneous edge-to-edge group (108-4079 vs. 2923-3603 with surgical MV reconstruction). Patients with percutaneous edge-to-edge MV reconstruction were older (75.6 ± 8.8 vs 61.6 ± 13.4 years, P < 0.001) and at higher operative risk (estimated logistic EuroSCORE 13.2% vs. 4.7%, P < 0.001) compared to those undergoing surgery. However, in-hospital mortality did not differ (2.9% vs. 2.8%; P = 0.395). This was also true for the subset of 2103 patients at intermediate operative risk as defined by a logistic EuroSCORE ≥ 4% and ≤ 9%. Of note, complication rates (except acute kidney injury) were more favorable in patients undergoing percutaneous edge-to-edge reconstruction.


CONCLUSIONS
Percutaneous edge-to-edge MV reconstruction has markedly changed clinical practice of MR therapy in Germany. Annual overall procedural numbers more than doubled, with a massive increase in percutaneous edge-to-edge procedures. Our data demonstrate its use mainly in high-risk patients and prove the favorable safety profile of this novel technique, with low in-hospital mortality and complication rates.
['Frankenstein|Lutz|L|http://orcid.org/0000-0001-7216-1004', 'Kaier|Klaus|K|', 'Katus|Hugo A|HA|', 'Bode|Christoph|C|', 'Wengenmayer|Tobias|T|', 'von Zur Mühlen|Constantin|C|', 'Bekeredjian|Raffi|R|', 'Täger|Tobias|T|', 'Zehender|Manfred|M|', 'Fröhlich|Hanna|H|', 'Stachon|Peter|P|']
D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D006328:Cardiac Catheterization D005260:Female D005858:Germany D017052:Hospital Mortality D006801:Humans D008297:Male D008875:Middle Aged D008943:Mitral Valve D008944:Mitral Valve Insufficiency D011183:Postoperative Complications D012307:Risk Factors D016896:Treatment Outcome
Surgical valve repair MitraClip Percutaneous mitral valve repair