Trends, Predictors, and Outcomes of Bleeding Complications After Mitral Transcatheter Edge-to-Edge Repair

Background

Bleeding events after arterial transcatheter procedures are associated with increased morbidity and mortality. The frequency and clinical implications of bleeding after mitral transcatheter edge-to-edge repair (M-TEER) have not been well-studied.

Objectives

The authors sought to explore the association of in-hospital bleeding events after M-TEER with patient outcomes.

Methods

Patients undergoing M-TEER who were included in the TVT (Transcatheter Valve Therapy) Registry between 2013 and 2022 were included. Rates of the primary endpoint, the composite of death or hospital readmission at 30 days, were compared between patients who experienced in-hospital major or life-threatening bleeding vs those without bleeding. Secondary analyses examined the association between in-hospital bleeding and death or readmission at 1 year, as well as independent predictors of major in-hospital bleeding.

Results

Over the study period, in-hospital major bleeding occurred in 1,205 (2.3%) of 51,533 patients. Rates of bleeding decreased over time (from 7.1% in 2013 to 2.0% in 2021; P < 0.001). In-hospital bleeding was associated with increased rates of death or readmission at both 30 days (adjusted OR: 2.15 [95% CI: 1.81-2.54]; P < 0.0001) and 1 year (adjusted HR: 1.43 [95% CI: 1.27-1.60]; P < 0.0001). The strongest correlates of in-hospital bleeding included female sex, prior percutaneous coronary intervention, baseline hemoglobin, greater procedure acuity, and longer procedure duration.

Conclusions

Bleeding after M-TEER is associated with increased risk of subsequent death and hospital readmission. Although reductions in bleeding complications over time are encouraging, continued efforts are needed to further mitigate hemorrhagic complications of M-TEER.