OBJECTIVES: TMVLR has been subsidized since July 2021 for treating patients with grade 3 or 4 (moderate-to-severe or severe) mitral regurgitation (MR) who are not eligible for surgery. This is the first study in Singapore to assess the impact of subsidies and outcomes of TMVLR procedures in the real-world setting.

METHODS: A prospective observational study was conducted to collect utilization volume, patient characteristics and outcomes (safety and effectiveness) from all specialty heart centers in the public sector. Data was submitted on a half-yearly basis and descriptive statistics was used for analysis.

RESULTS: The number of patients who underwent TMVLR pre- and post-subsidy remained stable, with about 21 patients each year. In the 18 months post-subsidy period (July 2021 to December 2022), 32 patients received TMVLR and its use was mostly in line with the subsidy criteria recommended by the Ministry of Health’s Medical Technology Advisory Committee (MTAC) (n = 27, 84%). The mean age of patients who received TMVLR was 74.5 ± 10.2 years old, with 22 of them (69%) having primary or degenerative MR and 27 of them (84%) with grade 4 MR. Most of the cases (n= 31, 97%) achieved procedural success with all patients attaining reduction in MR degree to grade 1 or 2 (mild or moderate) post-procedure. However, four of them (13%) experienced complications including pericardial effusion, atrial fibrillation and single-leaflet device attachment. At 30 days post-procedure, three patients (9%) were hospitalized due to congestive heart failure and two patients (6%) had cardiovascular-related deaths.

CONCLUSIONS: Utilization of TMVLR remained stable post-subsidy. TMVLR appeared to be effective in reducing MR degree; however, continuous monitoring is needed to better assess its safety. Despite the small patient population, this study contributes to the limited real-world data on TMVLR in Asia.