Tamburino Corrado, Buccheri Sergio, Popolo Rubbio Antonio, Scandura Salvatore, Di Salvo Maria Elena, Mangiafico Sarah, Immé Sebastiano, Caruso Giuseppe, Scalia Matteo, Condorelli Antonio, Barbanti Marco, Capranzano Piera, Capodanno Davide, Grasso Carmelo
Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
Heart. 2017 Jun;103(12):931-936. doi: 10.1136/heartjnl-2016-310501. Epub 2017 Jan 9.
Percutaneous edge-to-edge mitral valve repair (PMVR) recently emerged as an effective treatment modality for patients with severe mitral regurgitation (MR). Length of postprocedural hospital stay may represent a modifiable cost associated with percutaneous treatment. We looked at feasibility, predictors and safety of early discharge (ED), defined as hospital discharge within 72 hours, in patients undergoing PMVR.
Consecutive patients treated with MitraClip from October 2008 to December 2015 were analysed. Primary outcomes of interest were cardiovascular and non-cardiovascular mortality, rehospitalisation for heart failure and major adverse events at 30 days and 90 days. A total of 269 patients were included. Of these, 115 patients were early discharged (ED group). Rates of ED increased from 25.9% for the biennium 2008-2009 to 59.1% in 2014-2015 (p<0.001 for trend). In a penalised logistic regression model, male gender (OR=2.13, 95% CI 1.17 to 3.95) and procedural year (OR=2.13, 95% CI 1.51 to 3.11) were associated with higher probability of ED. Conversely, atrial fibrillation (OR=0.48, 95% CI 0.27 to 0.85), any Mitral Valve Academic Research Consortium bleeding (OR=0.07, 95% CI 0.01 to 0.60), log-transformed N-terminal pro-brain natriuretic peptide levels (OR=0.79, 95% CI 0.63 to 0.99) and postimplant MR grade (OR=0.60, 95% CI 0.37 to 0.94) conferred a lower likelihood of ED. In propensity score-weighted analyses, overall survival, freedom from heart failure and major adverse events at 30 days and 90 days were not different in ED and non-ED groups (all weighted log-rank p value>0.05).
In selected patients undergoing PMVR, ED may be feasible and safe.
经皮缘对缘二尖瓣修复术（PMVR）最近成为重度二尖瓣反流（MR）患者的一种有效治疗方式。术后住院时间可能是与经皮治疗相关的一个可改变的成本因素。我们研究了接受PMVR的患者中早期出院（定义为72小时内出院）的可行性、预测因素和安全性。
对2008年10月至2015年12月期间连续接受MitraClip治疗的患者进行分析。主要关注的结局是心血管和非心血管死亡率、因心力衰竭再次住院以及30天和90天时的主要不良事件。共纳入269例患者。其中，115例患者早期出院（早期出院组）。早期出院率从2008 - 2009两年期的25.9%增至2014 - 2015年的59.1%（趋势p<0.001）。在惩罚逻辑回归模型中，男性（比值比[OR]=
