Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address: https://twitter.com/A_Lowenstern.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
J Am Coll Cardiol. 2023 Feb 14;81(6):521-532. doi: 10.1016/j.jacc.2022.11.043.
The impact of transcatheter edge-to-edge repair (TEER) on national surgical mitral valve repair (MVr) volume and outcomes is unknown.
This study aims to assess the impact of TEER availability on MVr volumes and outcomes for degenerative mitral regurgitation.
MVr volume, 30-day and 5-year outcomes, including mortality, heart failure rehospitalization and mitral valve reintervention, were obtained from the Society of Thoracic Surgeons database linked with Medicare administrative claims and were compared within TEER centers before and after the first institutional TEER procedure. A difference-in-difference approach comparing parallel trends in coronary artery bypass grafting outcomes was used to account for temporal improvements in perioperative care.
From July 2011 through December 2018, 13,959 patients underwent MVr at 278 institutions, which became TEER-capable during the study period. There was no significant change in median annualized institutional MVr volume before (32 [IQR: 17-54]) vs after (29 [IQR: 16-54]) the first TEER (P = 0.06). However, higher-risk (Society of Thoracic Surgeons predicted risk of mortality ≥2%) MVr procedures declined over the study period (P < 0.001 for trend). The introduction of TEER was associated with reduced risk-adjusted odds of mortality after MVr at 30 days (adjusted OR: 0.73; 95% CI: 0.54-0.99) and over 5 years (adjusted HR: 0.75; 95% CI: 0.66-0.86). These improvements in 30-day and 5-year mortality were significantly greater than equivalent trends in coronary artery bypass grafting.
The introduction of TEER has not significantly changed overall MVr case volumes for degenerative mitral regurgitation but is associated with a decrease in higher-risk surgical operations and improved 30-day and 5-year outcomes within institutions adopting the technology.
经导管缘对缘修复（TEER）对全国二尖瓣修复（MVr）手术量和结果的影响尚不清楚。
本研究旨在评估 TEER 可用性对退行性二尖瓣反流患者 MVr 手术量和结果的影响。
从胸外科医师协会（STS）数据库中获得 MVr 手术量、30 天和 5 年结果（包括死亡率、心力衰竭再住院和二尖瓣再介入），并与医疗保险管理索赔数据相关联，并在首例 TEER 手术前后在 TEER 中心内进行比较。采用差异中的差异方法比较冠状动脉旁路移植术（CABG）结果的平行趋势，以考虑围手术期护理的时间改善。
2011 年 7 月至 2018 年 12 月，在 278 家机构进行了 13959 例 MVr 手术，这些机构在研究期间成为 TEER 能力机构。首例 TEER 前后，机构年均 MVr 手术量中位数无显著变化（32 [IQR：17-54] vs 29 [IQR：16-54]，P=0.06）。然而，高危（STS 预测死亡率风险≥2%）MVr 手术数量在研究期间有所下降（趋势 P<0.001）。TEER 的引入与 30 天死亡率的风险调整后 odds 降低相关（调整 OR：0.73；95%CI：0.54-0.99）和 5 年以上（调整 HR：0.75；95%CI：0.66-0.86）。30 天和 5 年死亡率的这些改善明显大于 CABG 的等效趋势。
TEER 的引入并没有显著改变退行性二尖瓣反流的整体 MVr 手术量，但与高危手术的减少以及采用该技术的机构中 30 天和 5 年生存率的提高相关。
