Kilic Arman, Grimm Joshua C, Magruder J Trent, Sciortino Christopher M, Whitman Glenn J R, Baumgartner William A, Conte John V
Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
J Thorac Cardiovasc Surg. 2015 Jun;149(6):1614-9. doi: 10.1016/j.jtcvs.2015.02.044. Epub 2015 Feb 28.
This study evaluated national trends, clinical outcomes, and cost implications of mitral valve (MV) repair, versus replacement, concomitant with aortic valve replacement (AVR).
Patients who underwent MV surgery concomitant with AVR, between 1999 and 2008, were identified in the Nationwide Inpatient Sample (NIS) registry. Mitral stenosis, endocarditis, and emergency cases were excluded. Inpatient clinical outcomes and costs were compared. Costs were derived using cost-to-charge ratios supplied by the dataset for each individual hospital. Multivariable logistic and linear regression analyses were used for risk adjustment.
A total of 41,417 concomitant cases were identified, of which 11,472 (28%) were MV repairs. Repair rates increased from 15.3% in 1999 to 43.5% in 2008 (P < .001). Major postoperative morbidity rates were similar with MV repair, versus replacement, concomitant with AVR (each 29%, P = .54). Unadjusted inpatient mortality (7.9% vs 10.1%, P = .005); length of hospital stay (median: 8 vs 9 days, P < .001); and costs (median: $45,455 vs $49,648, P < .001) were lower with MV repair. After risk adjustment, MV repair was associated with lower odds of inpatient mortality, and with lower costs (each P < .001).
Mitral valve repair concomitant with AVR is associated with reduced inpatient mortality and costs, compared with MV replacement, supporting its use when technically feasible. Although use has increased substantially, MV repair continues to comprise a minority of concomitant AVR cases, in centers reporting to the NIS registry. Increasing repair rates, particularly in NIS-participating hospitals, seems prudent.
本研究评估了二尖瓣（MV）修复术与置换术在同期行主动脉瓣置换术（AVR）时的全国趋势、临床结局及成本影响。
在全国住院患者样本（NIS）登记处中识别出1999年至2008年间同期行MV手术及AVR的患者。排除二尖瓣狭窄、心内膜炎及急诊病例。比较住院临床结局及成本。成本通过数据集提供的各医院成本收费比得出。采用多变量逻辑回归和线性回归分析进行风险调整。
共识别出41417例同期病例，其中11472例（28%）为MV修复术。修复率从1999年的15.3%增至2008年的43.5%（P < 0.001）。MV修复术与置换术在同期行AVR时的主要术后发病率相似（均为29%，P = 0.54）。未经调整的住院死亡率（7.9%对10.1%，P = 0.005）；住院时间（中位数：8天对9天，P < 0.001）；以及成本（中位数：45455美元对49648美元，P < 0.001），MV修复术更低。风险调整后，MV修复术与较低的住院死亡几率及较低成本相关（均P < 0.001）。
与MV置换术相比，同期行AVR时MV修复术与住院死亡率降低及成本降低相关，支持在技术可行时使用。尽管使用率大幅增加，但在向NIS登记处报告的中心，MV修复术在同期AVR病例中仍占少数。提高修复率，尤其是在参与NIS的医院，似乎是明智的。
