Department of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany.
Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Mainz, Germany.
Eur J Heart Fail. 2021 Aug;23(8):1380-1389. doi: 10.1002/ejhf.2162. Epub 2021 May 3.
The number of transcatheter mitral valve repair (TMVr) procedures has increased substantially during the last years. A better understanding of the relationship between hospital volume of transcatheter transvenous mitral valve repairs using MitraClip® and patient outcomes may provide information for future policy decisions to improve patient management.
We analysed patient characteristics and in-hospital outcomes for all TMVr procedures using MitraClip® performed in Germany from 2011 to 2017. Hospitals were stratified according to centre volumes and patients were compared for baseline characteristics and adverse in-hospital events. Overall, 24 709 inpatients were treated during the observational period. Patients treated in centres with a volume of ≤10 procedures annually developed more often pulmonary embolism (odds ratio 2.22, 95% confidence interval 1.19-4.13; P = 0.012) compared to those treated in centres with a volume of >10 procedures annually, whereas no association of centre volume (≤10 or >10) was found with in-hospital mortality (P = 0.728). Although patients treated in centres with an annual volume >25 TMVr procedures had higher numbers of comorbidities compared to those treated in centres with an annual volume of ≤25 TMVr procedures, in-hospital mortality did not differ (3.6% vs. 3.5%, P = 0.485). Similarly, when centre volumes were stratified for ≤50 vs. >50 procedural volumes, no association with in-hospital mortality was recorded (P = 0.792). A lower rate of mitral valve surgery after MitraClip® was observed over time, particularly in high-volume centres.
Annual numbers of MitraClip® implantations increased from 2011 to 2017 in Germany, whereas in-hospital mortality remained stable. Although patients treated in high-volume centres had a more unfavourable risk profile, in-hospital mortality was comparable to that of low-volume centres.
近年来，经导管二尖瓣修复术（TMVr）的数量大幅增加。更好地了解使用 MitraClip®进行经导管经静脉二尖瓣修复的医院数量与患者结局之间的关系，可能为未来的决策提供信息，以改善患者管理。
我们分析了 2011 年至 2017 年期间在德国进行的所有使用 MitraClip®的 TMVr 手术的患者特征和住院期间结局。根据中心数量对医院进行分层，比较患者的基线特征和不良住院事件。在观察期间，共有 24709 名住院患者接受了治疗。与每年接受治疗的中心数量>10 例的患者相比，每年接受治疗的中心数量≤10 例的患者更常发生肺栓塞（优势比 2.22，95%置信区间 1.19-4.13；P=0.012），而中心数量（≤10 例或>10 例）与住院期间死亡率无关联（P=0.728）。尽管每年接受治疗的中心数量>25 例 TMVr 手术的患者比每年接受治疗的中心数量≤25 例 TMVr 手术的患者有更多的合并症，但住院期间死亡率没有差异（3.6%比 3.5%，P=0.485）。同样，当中心数量按≤50 例和>50 例手术数量分层时，未记录到与住院期间死亡率的关联（P=0.792）。随着时间的推移，MitraClip®植入后的二尖瓣手术率下降，尤其是在高容量中心。
德国使用 MitraClip®的植入数量从 2011 年到 2017 年增加，而住院期间死亡率保持稳定。尽管在高容量中心治疗的患者风险状况更差，但住院期间死亡率与低容量中心相当。
