Department of Medicine, West Virginia University, Morgantown, West Virginia, USA.
Guthrie Clinic/Robert Packer Hospital, Sayre, Pennsylvania, USA.
Catheter Cardiovasc Interv. 2021 Feb 1;97(2):344-352. doi: 10.1002/ccd.29173. Epub 2020 Aug 8.
To evaluate contemporary national trends of morbidity, mortality, and healthcare utilization in patients with mitral regurgitation (MR) and co-existing chronic liver disease (CLD) undergoing transcatheter mitral valve repair (TMVR).
The National Inpatient Sample (NIS) was used to assess trends in patients undergoing TMVR between January 2012 and December 2017. Propensity match analysis was done to compare it to subjects without underlying CLD. Logistic regression analysis was used to identify predictors of in-hospital mortality.
Of 15,270 patients undergoing TMVR, 569 (3.7%) had coexisting CLD. Patients with CLD had a higher proportion of males (61.3 vs 52.6%; p < .01), congestive heart failure (6.9 vs 1.0%; p < .01), renal failure (42.2 vs 36.7%; p < .01), and peripheral vascular disease (19.3 vs 12.5%; p < .01). After propensity matching subjects with CLD had significantly higher hospital mortality (19.8 vs 4.6%; p < .01), acute kidney injury (46.1 vs 37.8%; p < .01), cardiogenic shock (25.4 vs 12.1%; p < .01), mechanical ventilation (26.3 vs 14.0; p < .01), pneumothorax (6.6 vs <2%.; p < .01), length of stay (5 vs 9 days), and average cost of hospitalization (209,573 vs 250,587 $; p < .01). Over the years, in-hospital mortality in patients receiving TMVR has improved in both patients with (from 33.3 in 2013 to 22.2% in 2017) and without CLD (from 2.7 in 2011 to 1.6% in 2017).
Patients with MR undergoing TMVR, with coexisting CLD bear substantially higher comorbidities, complication rates, and inpatient mortality compared with those without CLD. A favorable temporal trend of in-hospital mortality among these subjects is noteworthy.
评估经导管二尖瓣修复术（TMVR）治疗合并慢性肝病（CLD）的二尖瓣反流（MR）患者的发病率、死亡率和医疗保健利用的当代全国趋势。
使用国家住院患者样本（NIS）评估 2012 年 1 月至 2017 年 12 月间接受 TMVR 的患者的趋势。进行倾向匹配分析以将其与无潜在 CLD 的患者进行比较。使用 logistic 回归分析确定住院死亡率的预测因素。
在 15270 例接受 TMVR 的患者中，569 例（3.7%）合并 CLD。CLD 患者中男性比例更高（61.3%比 52.6%；p<.01），充血性心力衰竭（6.9%比 1.0%；p<.01），肾衰竭（42.2%比 36.7%；p<.01）和外周血管疾病（19.3%比 12.5%；p<.01）。在倾向匹配后，CLD 患者的住院死亡率显著更高（19.8%比 4.6%；p<.01），急性肾损伤（46.1%比 37.8%；p<.01），心源性休克（25.4%比 12.1%；p<.01），机械通气（26.3%比 14.0%；p<.01），气胸（6.6%比 <2%；p<.01），住院时间（5 比 9 天）和住院费用（209573 比 250587 美元；p<.01）。近年来，接受 TMVR 的患者的住院死亡率在合并 CLD 的患者中（从 2013 年的 33.3%到 2017 年的 22.2%）和无 CLD 的患者中（从 2011 年的 2.7%到 2017 年的 1.6%）均有所改善。
与无 CLD 的患者相比，接受 TMVR 治疗的 MR 合并 CLD 的患者的合并症、并发症发生率和住院死亡率明显更高。值得注意的是，这些患者的住院死亡率呈有利的时间趋势。
