Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
J Thorac Cardiovasc Surg. 2021 Aug;162(2):551-562.e4. doi: 10.1016/j.jtcvs.2019.12.097. Epub 2020 Jan 22.
The dissemination of mitral valve repair as the first-line treatment and the introduction of MitraClip for patients who have a prohibitive risk for surgery have changed the landscape of mitral valve intervention. The aim of this study is to provide current and generalizable data regarding the trend of mitral valve interventions and outcomes from 2000 to 2016.
Patients ≥18 years of age who underwent mitral-valve interventions were identified using the National Inpatient Sample database. National estimates were generated by means of discharge weights; comorbid conditions were identified using Elixhauser methods. All trends were analyzed with JoinPoint software.
A total of 656,030 mitral valve interventions (298,102 mitral valve replacement, 349,053 mitral valve repair, and 8875 MitraClip) were assessed. No changes in rate of procedures (per 100,000 people in the United States) were observed over this period (annual percent change, -0.4; 95% confidence limit, -1.1 to 0.3; P = .3). From 2000 to 2010, the number of replacements decreased by 5.6% per year (P < .001), whereas repair increased by 8.4% per year from 2000 to 2006 (P < .001). MitraClip procedures increased by 84.4% annually from 2013 to 2016 (P < .001). The burden of comorbidities increased throughout the study for all groups, with the greatest score for MitraClip recipients. Overall, length of stay has decreased for all interventions, most significantly for MitraClip. In-hospital mortality decreased from 8.5% to 3.7% for all interventions, with MitraClip having the most substantial decrease from 3.6% to 1.5%.
Over a 17-year period, mitral-valve interventions were associated with improved outcomes despite being applied to an increasingly sicker population.
二尖瓣修复作为一线治疗方法的推广以及 MitraClip 技术在手术禁忌风险患者中的应用，改变了二尖瓣介入治疗的格局。本研究旨在提供 2000 年至 2016 年期间二尖瓣介入治疗的趋势和结果的最新和普遍适用的数据。
利用国家住院患者样本数据库，确定≥18 岁接受二尖瓣瓣膜介入治疗的患者。采用出院权重生成全国估计数；采用 Elixhauser 方法确定合并症。使用 JoinPoint 软件分析所有趋势。
共评估了 656030 例二尖瓣介入治疗（298102 例二尖瓣置换术、349053 例二尖瓣修复术和 8875 例 MitraClip）。在此期间，手术率（每 10 万人中美国的人数）没有变化（年变化百分比为-0.4；95%置信区间为-1.1 至 0.3；P=0.3）。从 2000 年至 2010 年，置换术的数量每年减少 5.6%（P<0.001），而修复术从 2000 年至 2006 年每年增加 8.4%（P<0.001）。MitraClip 手术从 2013 年至 2016 年每年增加 84.4%（P<0.001）。在整个研究过程中，所有组的合并症负担都增加了，MitraClip 接受者的得分最高。总体而言，所有介入治疗的住院时间都有所减少，MitraClip 减少得最多。所有介入治疗的院内死亡率从 8.5%降至 3.7%，MitraClip 的死亡率从 3.6%降至 1.5%降幅最大。
在 17 年的时间里，尽管二尖瓣介入治疗应用于病情日益加重的人群，但仍与改善的结果相关。
