Implications of an Off-Hours Setting in Patients Undergoing Transcatheter Edge-to-Edge Repair for Mitral Regurgitation

Background: - Little is known about mitral transcatheter edge-to-edge repair (TEER) performed outside of usual working hours. We aimed to explore the prevalence, correlates, and outcomes of mitral TEER initiated off-hours, i.e. before 7:30 am, after 5:30 pm, or on weekends/holidays.

Methods: - A single-center registry of isolated, first-time interventions was retrospectively analyzed in its entirety and after propensity-score matching. Outcomes included all-cause mortality, heart failure (HF) hospitalizations, and the persistence of significant mitral regurgitation (MR) and functional incapacitation along the first postprocedural year.

Results: - A total of 1,177 procedures were studied. Of them, 117 (9.9%) took place off-hours. These were more often urgent interventions (30.8% vs. 14.3%, p<0.001) performed in the midst of acute HF / hemodynamic compromise and on individuals with greater comorbidity, more advanced HF, and higher interventional risk. Overall procedural features were unaffected by interventional timing, and a high (>97%) technical success rate was achieved unanimously. MR severity and functional class similarly improved from baseline in the two study groups. Deaths and the composite of deaths or HF hospitalizations occurred earlier and more frequently following off-hours procedures (18.8% vs. 11.5%, p=0.022 and 33.3% vs. 24.6%, p=0.040, respectively). None of the explored endpoints' risks were independently associated with procedural timing. Within a 234-patient, 1-to-1 matched sub-cohort, no inter-group differences were observed in pre-, intra-, and post-procedural findings and outcomes.

Conclusions: - A non-infrequent procedure, off-hours mitral TEER is performed in high-risk cases but, in the hands of experienced interventionalists, should prove safe, feasible, and efficacious.