Impact of Institutional Monthly Volume of Transcatheter Edge-to-Edge Repair Procedures for Significant Mitral Regurgitation: Evidence from the GIOTTO-VAT Study
Abstract
1. Introduction
2. Methods
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Central Illustration
References
- Feldman, T.; Foster, E.; Glower, D.D.; Kar, S.; Rinaldi, M.J.; Fail, P.S.; Smalling, R.W.; Siegel, R.; Rose, G.A.; Engeron, E.; et al. Percutaneous repair or surgery for mitral regurgitation. N. Engl. J. Med. 2011, 364, 1395–1406. [Google Scholar] [CrossRef] [PubMed]
- Stone, G.W.; Lindenfeld, J.; Abraham, W.T.; Kar, S.; Lim, D.S.; Mishell, J.M.; Whisenant, B.; Grayburn, P.A.; Rinaldi, M.; Kapadia, S.R.; et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N. Engl. J. Med. 2018, 379, 2307–2318. [Google Scholar] [CrossRef] [PubMed]
- Zhou, S.; Egorova, N.; Moskowitz, G.; Giustino, G.; Ailawadi, G.; Acker, M.A.; Gillinov, M.; Moskowitz, A.; Gelijns, A. Trends in MitraClip, mitral valve repair, and mitral valve replacement from 2000 to 2016. J. Thorac. Cardiovasc. Surg. 2021, 162, 551–562.e4. [Google Scholar] [CrossRef] [PubMed]
- Shi, W.; Zhang, W.; Zhang, D.; Ye, G.; Ding, C. Mortality and Clinical Predictors After Percutaneous Mitral Valve Repair for Secondary Mitral Regurgitation: A Systematic Review and Meta-Regression Analysis. Front. Cardiovasc. Med. 2022, 9, 918712. [Google Scholar] [CrossRef]
- Giordano, A.; Biondi-Zoccai, G.; Finizio, F.; Ferraro, P.; Denti, P.; Rubbio, A.P.; Petronio, A.S.; Bartorelli, A.L.; Mongiardo, A.; De Felice, F.; et al. Characteristics and outcomes of MitraClip in octogenarians: Evidence from 1853 patients in the GIOTTO registry. Int. J. Cardiol. 2021, 342, 65–71. [Google Scholar] [CrossRef]
- van-Roessel, A.M.; Asmarats, L.; Li, C.H.P.; Millán, X.; Fernández-Peregrina, E.; Menduiña, I.; Sanchez-Ceña, J.; Arzamendi, D. Mitral transcatheter edge-to-edge repair: Patient selection, current devices, and clinical outcomes. Expert. Rev. Med. Devices 2024, 21, 187–196. [Google Scholar] [CrossRef]
- Sonaglioni, A.; Nicolosi, G.L.; Bruno, A.; Lombardo, M.; Muti, P. Echocardiographic Assessment of Mitral Valve Prolapse Prevalence before and after the Year 1999: A Systematic Review. J. Clin. Med. 2024, 13, 6160. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
- Stolz, L.; Stocker, T.J.; Lurz, P.; Hausleiter, J. Growing Evidence for Edge-to-Edge Repair in Secondary Mitral Regurgitation: What to Learn From COAPT, MITRA-FR, and RESHAPE-HF2. JACC Cardiovasc. Interv. 2025, 18, 927–932. [Google Scholar] [CrossRef]
- Dimitriadis, K.; Soulaidopoulos, S.; Pyrpyris, N.; Sagris, Μ.; Aznaouridis, K.; Beneki, E.; Theofilis, P.; Tsioufis, P.; Tatakis, F.; Fragkoulis, C.; et al. Transcatheter Edge-to-Edge Repair for Severe Mitral Regurgitation in Patients with Cardiogenic Shock: A Systematic Review and Meta-Analysis. J. Am. Heart Assoc. 2025, 14, e034932. [Google Scholar] [CrossRef]
- Chhatriwalla, A.K.; Vemulapalli, S.; Holmes, D.R., Jr.; Dai, D.; Li, Z.; Ailawadi, G.; Glower, D.; Kar, S.; Mack, M.J.; Rymer, J.; et al. Institutional Experience With Transcatheter Mitral Valve Repair and Clinical Outcomes: Insights from the TVT Registry. JACC Cardiovasc. Interv. 2019, 12, 1342–1352. [Google Scholar] [CrossRef]
- Chhatriwalla, A.K.; Vemulapalli, S.; Szerlip, M.; Kodali, S.; Hahn, R.T.; Saxon, J.T.; Mack, M.J.; Ailawadi, G.; Rymer, J.; Manandhar, P.; et al. Operator Experience and Outcomes of Transcatheter Mitral Valve Repair in the United States. J. Am. Coll. Cardiol. 2019, 74, 2955–2965. [Google Scholar] [CrossRef] [PubMed]
- Bonow, R.O.; O’Gara, P.T.; Adams, D.H.; Badhwar, V.; Bavaria, J.E.; Elmariah, S.; Hung, J.W.; Lindenfeld, J.; Morris, A.; Satpathy, R.; et al. 2019 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Mitral Valve Intervention: A Joint Report of the American Association for Thoracic Surgery, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and The Society of Thoracic Surgeons. J. Am. Coll. Cardiol. 2020, 76, 96–117. [Google Scholar] [PubMed]
- Basso, C.; Musumeci, G.; Saia, F.; Tarantini, F. Percutaneous Approaches to Mitral Valve Disease; Minerva Medica: Torino, Italy, 2019. [Google Scholar]
- Kolte, D.; Butala, N.M.; Kennedy, K.F.; Wasfy, J.H.; Jena, A.B.; Sakhuja, R.; Langer, N.; Melnitchouk, S.; Sundt, T.M., III; Passeri, J.J.; et al. Association Between Hospital Cardiovascular Procedural Volumes and Transcatheter Mitral Valve Repair Outcomes. Cardiovasc. Revasc. Med. 2022, 36, 27–33. [Google Scholar] [CrossRef]
- Keller, K.; Hobohm, L.; Schmidtmann, I.; Münzel, T.; Baldus, S.; von Bardeleben, R.S. Centre procedural volume and adverse in-hospital outcomes in patients undergoing percutaneous transvenous edge-to-edge mitral valve repair using MitraClip® in Germany. Eur. J. Heart Fail. 2021, 23, 1380–1389. [Google Scholar] [CrossRef]
- Shoji, S.; Kuno, T.; Malik, A.; Briasoulis, A.; Inohara, T.; Kampaktsis, P.N.; Kohsaka, S.; Latib, A. Association between institutional volume of transcatheter mitral valve repair and readmission rates: A report from the Nationwide Readmission Database. Int. J. Cardiol. 2023, 383, 70–74. [Google Scholar] [CrossRef]
- Bansal, K.; Pawar, S.; Gupta, T.; Gilani, F.; Khera, S.; Kolte, D. Association Between Hospital Volume and 30-Day Readmissions After Transcatheter Mitral Valve Edge-to-Edge Repair. Am. J. Cardiol. 2023, 203, 149–156. [Google Scholar] [CrossRef]
- Nita, N.; Schneider, L.; Dahme, T.; Markovic, S.; Keßler, M.; Rottbauer, W.; Tadic, M. Trends in Transcatheter Edge-to-Edge Mitral Valve Repair Over a Decade: Data From the MiTra ULM Registry. Front. Cardiovasc. Med. 2022, 9, 850356. [Google Scholar] [CrossRef]
- Stone, G.W. Volume-Outcome Relationships for Transcatheter Mitral Valve Repair: More Is Better. JACC Cardiovasc. Interv. 2019, 12, 1353–1355. [Google Scholar] [CrossRef]
- Grayburn, P.A.; Mack, M.J.; Manandhar, P.; Kosinski, A.S.; Sannino, A.; Smith, R.L., II; Szerlip, M.; Vemulapalli, S. Comparison of Transcatheter Edge-to-Edge Mitral Valve Repair for Primary Mitral Regurgitation Outcomes to Hospital Volumes of Surgical Mitral Valve Repair. Circ. Cardiovasc. Interv. 2024, 17, e013581. [Google Scholar] [CrossRef]
- Halm, E.A.; Lee, C.; Chassin, M.R. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann. Intern. Med. 2002, 137, 511–520. [Google Scholar] [CrossRef]
- Steitieh, D.; Zaidi, A.; Xu, S.; Cheung, J.W.; Feldman, D.N.; Reisman, M.; Mallya, S.; Paul, T.K.; Singh, H.S.; Bergman, G.; et al. Racial Disparities in Access to High-Volume Mitral Valve Transcatheter Edge-to-Edge Repair Centers. J. Soc. Cardiovasc. Angiogr. Inter. 2022, 1, 100398. [Google Scholar] [CrossRef] [PubMed]
- Safieddine, M.; Chapelle, C.; Ollier, E.; Ferdynus, C.; Bertoletti, L.; Mismetti, P.; Cucherat, M.; Laporte, S. Compared to randomized studies, observational studies may overestimate the effectiveness of DOACs: A metaepidemiological approach. J. Clin. Epidemiol. 2021, 130, 49–58. [Google Scholar] [CrossRef]
Feature | First Tertile | Second Tertile | Third Tertile | p |
---|---|---|---|---|
Patients | 645 | 947 | 621 | - |
Age (years) | 78 (72; 83) | 77 (70; 82) | 79 (70; 83) | <0.001 ¶,$ |
Female gender | 211 (32.7%) | 586 (61.9%) | 380 (61.2%) | 0.039 |
Body mass index | 24.9 (22.7; 27.6) | 24.8 (22.1; 27.8) | 23.4 (2.0; 25.6) | 0.356 |
Smoking history | 72 (11.1%) | 88 (9.3%) | 163 (26.3%) | <0.001 |
Hypertension | 462 (71.6%) | 696 (73.5%) | 445 (71.7%) | 0.628 |
Dyslipidemia | 212 (32.9%) | 256 (27.0%) | 267 (43.0%) | <0.001 |
Diabetes mellitus | 157 (24.3%) | 220 (23.2%) | 144 (23.2%) | 0.851 |
Diagnosis | 0.002 | |||
Degenerative MR | 176 (27.3%) | 330 (34.9%) | 198 (31.9%) | |
Functional dilated MR | 199 (30.9%) | 277 (29.3%) | 180 (29.0%) | |
Functional ischemic MR | 194 (30.1%) | 230 (24.3%) | 194 (31.2%) | |
Mixed etiology | 76 (11.8%) | 110 (11.6%) | 49 (7.9%) | |
New York Heart Association class | <0.001 | |||
I | 4 (0.6%) | 11 (1.2%) | 17 (2.8%) | |
II | 110 (17.1%) | 215 (22.7%) | 196 (31.9%) | |
III | 452 (70.1%) | 660 (69.7%) | 350 (57.0%) | |
IV | 79 (12.3%) | 61 (6.4%) | 51 (8.3%) | |
Coronary artery disease | 0.711 | |||
None | 201 (63.8%) | 134 (60.1%) | 275 (64.0%) | |
Single vessel disease | 49 (15.6%) | 42 (18.8%) | 67 (15.6%) | |
Two vessel disease | 25 (7.9%) | 23 (10.3%) | 48 (11.2%) | |
Three vessel disease | 22 (7.0%) | 13 (5.8%) | 22 (5.1%) | |
Left main disease | 18 (5.7%) | 11 (4.9%) | 18 (4.2%) | |
Prior pacemaker implantation | ||||
Prior myocardial infarction | 213 (33.0%) | 312 (33.0%) | 194 (31.2%) | 0.735 |
Prior coronary artery bypass grafting | 83 (12.9%) | 126 (13.3%) | 104 (16.8%) | 0.087 |
Prior mitral valve intervention | 17 (2.6%) | 14 (1.5%) | 38 (6.1%) | <0.001 |
Prior cerebrovascular event | <0.001 | |||
None | 601 (93.2%) | 891 (94.1%) | 548 (88.2%) | |
Transient ischemic attack | 12 (1.9%) | 14 (1.5%) | 31 (5.0%) | |
Minor stroke | 17 (2.6%) | 22 (2.3%) | 12 (1.9%) | |
Major stroke | 15 (2.3%) | 20 (2.1%) | 30 (4.8%) | |
Peripheral artery disease | 54 (8.4%) | 38 (4.0%) | 74 (11.9%) | <0.001 |
Frailty | 116 (18.0%) | 118 (12.5%) | 418 (67.3%) | <0.001 |
Dialysis | 15 (2.3%) | 18 (1.9%) | 9 (1.5%) | 0.521 |
Logistic EuroSCORE | 10.5 (6.5; 16.4) | 10.4 (6.2; 19.5) | 3.9 (3.4; 4.5) | 0.007 ¶,# |
CHADS2 score | 2 (2; 3) | 2 (2; 3) | 2 (1; 3) | 0.004 ¶,# |
CHADS2Vasc score | 4 (3; 5) | 4 (3; 5) | 4 (3; 4) | 0.443 |
Feature | First Tertile | Second Tertile | Third Tertile | p |
---|---|---|---|---|
Patients | 645 | 947 | 621 | - |
LA AP diameter (mm) | 45 (40; 50) | 49 (44; 55) | 49 (45; 55) | 0.089 |
LV EDD (mm) | 61 (54; 68) | 58 (52; 64) | 58 (50; 65) | <0.001 ¶,# |
LV ESD (mm) | 49 (38; 56) | 41 (33; 51) | 45 (35; 54) | <0.001 ¶,#,$ |
LV EDV (mL) | 164 (120; 212) | 137 (105; 181) | 140 (100; 189) | <0.001 ¶,# |
LV ESV (mL) | 97 (55; 146) | 73 (48; 116) | 81 (47; 130) | <0.001 ¶,#,$ |
LVEF (%) | 38 (30; 55) | 42 (31; 55) | 40 (30; 57) | 0.008 ¶ |
Tenting area (cm2) | 3.0 (2.2; 3.7) | 2.3 (1.6; 3.0) | 1.9 (1.3; 2.4) | <0.001 ¶,#,$ |
Mean mitral valve gradient (mm Hg) | 2 (1; 3) | 2 (1; 2) | 2 (2; 3) | 0.148 |
Severe mitral regurgitation | 495 (76.7%) | 739 (78.0%) | 493 (79.4%) | 0.525 |
Severe mitral calcification | 22 (3.4%) | 28 (3.0%) | 55 (8.9%) | <0.001 |
Mitral valve prolapse | 163 (25.3%) | 262 (27.7%) | 205 (33.0%) | 0.007 |
Flail leaflet | 132 (20.5%) | 176 (18.6%) | 146 (23.5%) | 0.063 |
Tricuspid regurgitation | <0.001 | |||
None or trace | 23 (3.6%) | 62 (6.6%) | 22 (3.5%) | |
Mild | 282 (43.7%) | 324 (34.2%) | 234 (37.7%) | |
Moderate | 273 (42.3%) | 458 (48.4%) | 239 (38.5%) | |
Severe | 67 (10.4%) | 103 (10.9%) | 126 (20.3%) | |
Systolic pulmonary artery pressure (mm Hg) | 46 (40; 55) | 45 (37; 55) | 45 (35; 55) | 0.071 |
Any ECG abnormality | 152 (23.6%) | 163 (17.2%) | 296 (47.7%) | <0.001 |
Second-degree atrioventricular block | 1 (0.2%) | 0 | 3 (0.5%) | 0.039 |
Third-degree atrioventricular block | 1 (0.2%) | 4 (0.4%) | 2 (0.3%) | 0.806 |
Right bundle branch block | 17 (2.6%) | 20 (2.1%) | 18 (2.9%) | 0.577 |
Left bundle branch block | 27 (4.2%) | 27 (2.9%) | 28 (4.5%) | 0.165 |
Atrial fibrillation | 111 (17.2%) | 118 (12.5%) | 248 (39.9%) | <0.001 |
Coronary angiography performed | 315 (48.8%) | 223 (23.6%) | 430 (69.2%) | <0.001 |
Coronary artery disease | 0.711 | |||
No | 201 (63.8%) | 134 (60.1%) | 275 (64.0%) | |
1-vessel disease | 49 (15.6%) | 42 (18.8%) | 67 (15.6%) | |
2-vessel disease | 25 (7.9%) | 23 (10.3%) | 48 (11.2%) | |
3-vessel disease | 22 (7.0%) | 13 (5.8%) | 22 (5.1%) | |
Left main disease | 18 (5.7%) | 11 (4.9%) | 18 (4.2%) |
Outcome | First Tertile | Second Tertile | Third Tertile | p |
---|---|---|---|---|
Patients | 645 | 947 | 621 | |
Implantation of ≥2 MitraClip devices | 421 (65.3%) | 508 (53.6%) | 377 (60.7%) | <0.001 |
Implantation on NT device | 433 (67.1%) | 499 (52.7%) | 308 (49.6%) | <0.001 |
Implantation on NTr device | 98 (15.2%) | 178 (18.8%) | 92 (14.8%) | 0.062 |
Implantation of XTr device | 160 (24.8%) | 358 (37.8%) | 249 (40.1%) | <0.001 |
Device time (minutes) | 2.3 (1.5; 3.5) | 2.1 (1.5; 2.7) | 3.5 (2.1; 4.4) | <0.001 ¶,#,$ |
Fluoroscopy time (minutes) | 0.8 (0.6; 1.7) | 1.3 (0.8; 1.9) | 0.4 (0.2; 0.8) | <0.001 #,$ |
Device success | 641 (99.4%) | 942 (99.5%) | 620 (99.8%) | 0.513 |
Procedural success | 600 (93.0%) | 926 (97.8%) | 593 (95.5%) | <0.001 |
Procedural death | 3 (0.5%) | 0 | 2 (03%) | 0.104 |
Mean mitral valve gradient at end of procedure | 3 (2; 4) | 3 (2; 4) | 3 (3; 5) | <0.001 ¶,#,$ |
Mitral regurgitation at end of procedure | <0.001 | |||
None | 386 (59.8%) | 561 (59.2%) | 453 (73.0%) | |
Mild | 209 (32.4%) | 348 (36.8%) | 147 (23.7%) | |
Moderate | 34 (5.3%) | 26 (2.8%) | 12 (1.9%) | |
Severe | 16 (2.5%) | 12 (1.3%) | 9 (1.5%) | |
Inhospital death | 18 (2.8%) | 20 (2.1%) | 24 (3.9%) | 0.123 |
Inhospital stroke | 0 | 0 | 0 | - |
Inhospital bleeding | 0.006 | |||
None | 644 (99.8%) | 939 (99.2%) | 610 (98.2%) | |
Minor | 0 | 5 (0.5%) | 7 (1.1%) | |
Major | 0 | 1 (0.1%) | 4 (0.6%) | |
Disabling | 1 (0.2%) | 2 (0.2%) | 0 | |
Inhospital vascular complication | 1 (0.2%) | 5 (0.5%) | 10 (1.6%) | 0.008 |
Days of hospitalization | 8 (5; 12) | 5 (4; 8) | 5 (4; 8) | <0.001¶,#,$ |
Mitral regurgitation at discharge | 0.001 | |||
None | 347 (55.3%) | 503 (54.3%) | 388 (65.0%) | |
Mild | 226 (36.0%) | 354 (38.2%) | 171 (28.6%) | |
Moderate | 39 (6.2%) | 59 (6.4%) | 27 (4.5%) | |
Severe | 15 (2.4%) | 11 (1.2%) | 11 (1.0%) | |
Systolic pulmonary artery pressure (mm Hg) | 40 (32; 46) | 40 (35; 50) | 40 (30; 45) | <0.001 ¶,$ |
Outcome | First Tertile | Second Tertile | Third Tertile | p |
---|---|---|---|---|
Patients | 645 | 947 | 621 | |
Follow-up (months) | 12 (1; 24) | 21 (10; 36) | 13 (1; 25) | <0.001 ¶,$ |
Death | 152 (23.6%) | 251 (26.5%) | 136 (21.9%) | 0.101 |
Cardiac death | 86 (13.3%) | 125 (13.2%) | 75 (12.1%) | 0.764 |
Hospitalization | 107 (16.6%) | 114 (12.0%) | 68 (11.0%) | 0.007 |
Hospitalization for heart failure | 82 (12.7%) | 86 (9.1%) | 65 (10.5%) | 0.070 |
Death or hospitalization | 199 (30.1%) | 307 (32.4%) | 179 (28.8%) | 0.323 |
Cardiac death or hospitalization for heart failure | 142 (22.0%) | 189 (20.0%) | 127 (20.5%) | 0.596 |
Mitral valve surgery | 4 (0.6%) | 8 (0.8%) | 13 (2.1%) | 0.034 |
Cerebrovascular accident | 12 (1.9%) | 13 (1.4%) | 9 (1.5%) | 0.722 |
New York Heart Association class | 0.006 | |||
I | 59 (14.0%) | 159 (21.3%) | 55 (13.3%) | |
I | 270 (64.0%) | 425 (56.9%) | 254 (61.2%) | |
III | 85 (20.1%) | 153 (20.5%) | 98 (23.6%) | |
IV | 8 (1.9%) | 10 (1.3%) | 8 (1.9%) | |
Atrial fibrillation | 124 (19.2%) | 135 (14.3%) | 258 (41.6%) | <0.001 |
End-diastolic diameter (mm) | 60 (53; 67) | 57 (50; 64) | 56 (49; 62) | <0.001 ¶,$ |
End-systolic diameter (mm) | 48 (38; 56) | 40 (31; 50) | 40 (35; 53) | <0.001 ¶,#,$ |
End-diastolic volume (mL) | 159 (120; 220) | 131 (100; 180) | 133 (98; 187) | <0.001 ¶,# |
End-systolic volume (mL) | 90 (56; 138) | 73 (45; 115) | 85 (45; 130) | 0.004 ¶ |
Left ventricular ejection fraction (%) | 38 (28; 51) | 42 (30; 55) | 38 (27; 52) | <0.001 ¶,$ |
Mean mitral valve gradient (mm Hg) | 3 (3; 5) | 4 (3; 5) | 4 (3; 5) | 0.023 # |
Mitral regurgitation | 0.113 | |||
None | 281 (44.7%) | 433 (46.7%) | 297 (49.8%) | |
Mild | 250 (39.8%) | 365 (39.4%) | 219 (36.7%) | |
Moderate | 66 (10.5%) | 103 (11.1%) | 53 (8.9%) | |
Severe | 32 (5.1%) | 26 (2.8%) | 28 (4.7%) | |
Angiotensin receptor blockers | 219 (52.4%) | 246 (33.1%) | 85 (22.3%) | <0.001 |
Calcium channel antagonists | 34 (8.1%) | 77 (10.4%) | 41 (10.8%) | 0.367 |
Betablockers | 348 (82.7%) | 362 (75.4%) | 299 (78.3%) | 0.015 |
Ivabradine | 23 (5.5%) | 30 (4.0%) | 18 (4.7%) | 0.495 |
Furosemide | 393 (92.7%) | 677 (90.6%) | 361 (90.5%) | 0.421 |
Aspirin | 185 (44.2%) | 318 (42.5%) | 183 (48.3%) | 0.183 |
Thienopyridines | 64 (15.4%) | 161 (21.6%) | 89 (23.5%) | <0.001 |
Novel oral anticoagulants | 154 (24.8%) | 262 (28.6%) | 113 (18.7%) | <0.001 |
Warfarin | 167 (26.9%) | 221 (24.2%) | 148 (24.6%) | 0.455 |
Intravenous inotropes | 11 (2.6%) | 3 (0.4%) | 6 (1.6%) | 0.003 |
Outcome | Unadjusted Effect Estimates | Adjusted Effect Estimates |
---|---|---|
Death | ||
Tertile 2 vs. 1 | 0.78 (0.64–0.96), p = 0.018 | 0.60 (0.19–1.82), p = 0.364 |
Tertile 3 vs. 1 | 0.90 (0.71–1.13), p = 0.365 | 0.54 (0.16–1.78), p = 0.308 |
Tertile 3 vs. 2 | 1.28 (0.93–1.42), p = 0.191 | 0.90 (0.36–2.21), p = 0.814 |
Cardiac death | ||
Tertile 2 vs. 1 | 0.70 (0.53–0.93), p = 0.015 | 0.55 (0.14–2.21), p = 0.398 |
Tertile 3 vs. 1 | 0.89 (0.65–1.21), p = 0.456 | 0.44 (0.09–2.12), p = 0.304 |
Tertile 3 vs. 2 | 1.26 (0.94–1.69), p = 0.117 | 0.80 (0.24–2.68), p = 0.713 |
Death or hospitalization | ||
Tertile 2 vs. 1 | 0.80 (0.67–0.96), p = 0.014 | 0.63 (0.24–1.66), p = 0.351 |
Tertile 3 vs. 1 | 0.89 (0.72–1.09), p = 0.246 | 0.37 (0.13–1.07), p = 0.065 |
Tertile 3 vs. 2 | 1.11 (0.92–1.34), p = 0.265 | 0.59 (0.25–1.36), p = 0.213 |
Cardiac death or hospitalization for heart failure | ||
Tertile 2 vs. 1 | 0.64 (0.50–0.82), p < 0.001 | 0.62 (0.16–2.37), p = 0.488 |
Tertile 3 vs. 1 | 0.83 (0.64–1.09), p < 0.001 | 0.16 (0.03–0.81), p = 0.026 |
Tertile 3 vs. 2 | 1.30 (1.01–1.69), p = 0.045 | 0.26 (0.07–0.99), p = 0.048 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Corcione, N.; Ferraro, P.; Finizio, F.; Cimmino, M.; Albanese, M.; Morello, A.; Biondi-Zoccai, G.; Denti, P.; Rubbio, A.P.; Bedogni, F.; et al. Impact of Institutional Monthly Volume of Transcatheter Edge-to-Edge Repair Procedures for Significant Mitral Regurgitation: Evidence from the GIOTTO-VAT Study. Medicina 2025, 61, 904. https://doi.org/10.3390/medicina61050904
Corcione N, Ferraro P, Finizio F, Cimmino M, Albanese M, Morello A, Biondi-Zoccai G, Denti P, Rubbio AP, Bedogni F, et al. Impact of Institutional Monthly Volume of Transcatheter Edge-to-Edge Repair Procedures for Significant Mitral Regurgitation: Evidence from the GIOTTO-VAT Study. Medicina. 2025; 61(5):904. https://doi.org/10.3390/medicina61050904
Chicago/Turabian StyleCorcione, Nicola, Paolo Ferraro, Filippo Finizio, Michele Cimmino, Michele Albanese, Alberto Morello, Giuseppe Biondi-Zoccai, Paolo Denti, Antonio Popolo Rubbio, Francesco Bedogni, and et al. 2025. "Impact of Institutional Monthly Volume of Transcatheter Edge-to-Edge Repair Procedures for Significant Mitral Regurgitation: Evidence from the GIOTTO-VAT Study" Medicina 61, no. 5: 904. https://doi.org/10.3390/medicina61050904
APA StyleCorcione, N., Ferraro, P., Finizio, F., Cimmino, M., Albanese, M., Morello, A., Biondi-Zoccai, G., Denti, P., Rubbio, A. P., Bedogni, F., Bartorelli, A. L., Mongiardo, A., Giordano, S., De Felice, F., Adamo, M., Montorfano, M., Maisano, F., Tarantini, G., Giannini, F., ... Giordano, A. (2025). Impact of Institutional Monthly Volume of Transcatheter Edge-to-Edge Repair Procedures for Significant Mitral Regurgitation: Evidence from the GIOTTO-VAT Study. Medicina, 61(5), 904. https://doi.org/10.3390/medicina61050904