A US analysis comparing trends in transcatheter and surgical mitral valve repair (SMVR) has found a “significant” increase in the use of transcatheter edge-to-edge repair (TEER) relative to the use of SMVR in recent years.
The analysis authored by Michael N Young and Alexander Iribarne (Geisel School of Medicine at Dartmouth, Lebanon, USA) et al, findings of which were published as a research letter in JAMA Cardiology, used data from the Medicare Provider Analysis and Review (MedPAR) File from 2012 to 2019 for all fee-for-service Medicare beneficiaries undergoing SMVR (n=34,375) and TEER (16,931).
Young and colleagues write that they observed a significant increase in the use of TEER relative to the use of SMVR among beneficiaries over the course of the eight years included in the analysis. They note that, in 2012, the rate of TEER use was 0.76 per 100,000 beneficiaries, a rate that increased to 17.95 by 2019 (p<0.001). In contrast, they add, SMVR use decreased from 16.06 to 13.58 per 100,000 (p=0.04). The annualised ratio of TEER to SMVR increased from 0.05 to 1.32 (p<0.001).
The number of hospitals performing TEER grew from 91 in 2013 to 396 in 2019, and the median distance to care decreased from 44.2 miles in 2012 to 19.0 in 2019 (p=0.003), the researchers found, noting that the number of hospitals performing SMVR remained consistent between 2012 and 2019 (730 and 721), and the median distance to care increased from 17.2 miles in 2012 to 21.7 in 2019 (p=0.001).
“The growth in TEER closely follows approval of the MitraClip (Abbott), with an initial rise in 2013 after its approval for primary MR [mitral regurgitation] and continued growth in 2019 after its approval for secondary MR,” Young and colleagues note.
“During the study period, SMVR use remained stable, while TEER continued to grow,” they continue. “This phenomenon has also been observed for transcatheter aortic valve replacement. Notably, we found that use of TEER surpassed that of SMVR by mid-2018, suggesting TEER has become a new option for patients who might not have been candidates for surgery, such as those at high surgical risk or with left ventricular dysfunction and secondary MR in whom medical therapy has failed.”
The researchers also found significant geographical dispersion of TEER and hospitals performing TEER throughout the USA and observed variation in the use of TEER versus SMVR among demographic subgroups, with use of both TEER or SMVR being lower among female patients and members of racial or ethnic minority groups. “These disparities could be associated with inherent differences in epidemiological factors as well as other social determinants of health or treatment biases,” they write.