Impact of Frailty on Outcomes After Transcatheter Edge-to-Edge Repair with MitraClip (from the National Inpatient Sample 2021-2022).

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BACKGROUND: Frailty profoundly influences procedural outcomes in cardiovascular interventions. Although its effect is well established in transcatheter aortic valve replacement (TAVR), data remains limited for mitral transcatheter edge-to-edge repair (TEER). We evaluated the impact of frailty (defined by the Johns Hopkins Adjusted Clinical Groups Indicator) and the prevalence of associated comorbidities on in-hospital outcomes after TEER. METHODS: Adults (≥18 years) undergoing TEER were identified from the National Inpatient Sample (NIS) 2021-2022. Frailty was defined per the Adjusted Clinical Group (ACG) criteria, and patients were categorized as frail or nonfrail. The primary endpoint was in-hospital mortality. The secondary endpoints included: length of stay (LOS), hospitalization costs, and comorbidities associated with mortality. Univariate and multivariable logistic and linear regressions adjusted for demographics and comorbidities were conducted where appropriate. RESULTS: Among 26,196 weighted TEER hospitalizations, 2,130 (8.13 %) met frailty criteria. Frailty was associated with four-fold higher odds of in-hospital mortality (OR 4.03, 95 % CI 2.97-5.44, p < 0.001). Independent predictors of mortality included end-stage renal disease (ESRD, OR 13.67), heart failure (OR 3.38), chronic liver disease (OR 2.60), and CKD stage 3-5 (OR 1.92). Obesity showed no association with mortality. Frail patients had longer LOS (10.9 vs 3.3 days, p < 0.001) and higher mean costs ($377,688 vs $230,650, p < 0.001). CONCLUSIONS: Frailty is present in approximately 8 % of TEER patients and is strongly associated with increased mortality and resource utilization. Routine frailty screening may help optimize patient selection and post-procedural care.

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