Department of Cardiovascular Medicine Mayo Clinic Rochester MN.
Division of Cardiology Department of Medicine University of Kentucky Lexington KY.
J Am Heart Assoc. 2021 Apr 6;10(7):e019314. doi: 10.1161/JAHA.120.019314. Epub 2021 Mar 23.
Background Transcatheter mitral valve repair (TMVr) is currently offered at selected centers that meet certain operator and institutional requirements. We sought to explore the hypothesis that the availability of TMVr is associated with improved outcomes of MV surgery. Methods and Results We used the Nationwide Readmissions Database to identify patients who underwent MV surgery at centers with or without TMVr capabilities between January 1 and December 31, 2017. The primary end point was in-hospital mortality. Secondary end points were postoperative complications, resource use, and 30-day readmissions. A total of 24 477 patients from 595 centers (446 TMVr, 149 non-TMVr) were included. There were modest but statistically significant differences in the prevalence of comorbidities between the groups. Patients at non-TMVr centers had higher unadjusted in-hospital mortality than those at TMVr centers (5.6% versus 3.6%, <0.001). They also had higher rates of postoperative complications, longer hospitalizations, higher cost, and fewer home discharges but similar 30-day readmission rates. After propensity matching, mortality remained higher at non-TMVr centers (5.5% versus 4.0%, <0.001). Rates of postoperative complications, prolonged hospitalizations, and nonhome discharges also remained higher. Postoperative mortality was consistently higher at non-TMVr centers in multiple risk-adjustment analyses incrementally accounting for differences in risk factors, surgical volume, availability of surgical repair, and excluding concomitant procedures. In the most comprehensive model, surgery at non-TMVr centers was associated with higher odds of death (odds ratio, 1.41; 95% CI, 1.14-1.73; =0.002). Conclusions Mitral valve surgery at TMVr centers is associated with improved in-hospital outcomes compared with non-TMVr centers.
背景 经导管二尖瓣修复术（TMVr）目前仅在符合特定术者和机构要求的选定中心提供。我们试图探讨这样一种假设，即 TMVr 的可及性与二尖瓣手术结果的改善相关。
方法和结果 我们使用全国再入院数据库，确定 2017 年 1 月 1 日至 12 月 31 日期间在具有或不具有 TMVr 能力的中心接受二尖瓣手术的患者。主要终点是院内死亡率。次要终点是术后并发症、资源利用和 30 天再入院率。共纳入来自 595 个中心的 24477 名患者（446 名 TMVr，149 名非 TMVr）。两组患者的合并症患病率存在差异，但差异较小，具有统计学意义。非 TMVr 中心的患者未校正院内死亡率高于 TMVr 中心（5.6%比 3.6%，<0.001）。他们的术后并发症发生率、住院时间、费用更高，出院回家的比例较低，但 30 天再入院率相似。在倾向匹配后，非 TMVr 中心的死亡率仍然较高（5.5%比 4.0%，<0.001）。术后并发症、住院时间延长和非出院回家的发生率也仍然较高。在多个风险调整分析中，非 TMVr 中心的术后死亡率始终较高，这些分析逐步考虑了危险因素、手术量、手术修复的可及性以及排除伴随手术的差异。在最全面的模型中，非 TMVr 中心的手术与更高的死亡风险相关（比值比，1.41；95%置信区间，1.14-1.73；=0.002）。
结论 与非 TMVr 中心相比，TMVr 中心的二尖瓣手术与改善的院内结局相关。
