Division of Cardiovascular Disease, Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiovascular Disease, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Division of Cardiovascular Disease, Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiovascular Disease, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Am J Cardiol. 2023 Dec 15;209:184-189. doi: 10.1016/j.amjcard.2023.09.089. Epub 2023 Oct 16.
Patients with persistent severe mitral regurgitation after transcatheter aortic valve replacement (TAVR) may benefit from mitral transcatheter edge-to-edge repair (M-TEER). Using the Nationwide Readmission Database, we identified patients who had M-TEER within 6 months after TAVR and compared their outcomes with patients who had M-TEER without previous recent TAVR during the same calendar year between 2014 and 2020. Because Nationwide Readmission Database data do not cross years, analysis was restricted to the last half of each calendar year. End points included in-hospital mortality and 30-day and 90-day postdischarge rehospitalization rates. In 23,885 M-TEER patients, 396 (1.7%) had a previous recent TAVR. The number of post-TAVR M-TEER procedures increased progressively over time from 16 in 2014 to 92 in 2020. Patients who had M-TEER after a recent TAVR versus those without previous TAVR had similar in-hospital mortality (adjusted odds ratio 0.38, 95% confidence interval [CI] 0.12 to 1.23, p = 0.11), but higher rates of 30-day all-cause hospitalization and heart failure hospitalization (adjusted odds ratios 1.34, 95% CI 1.11 to 1.79, p = 0.04 and 1.63, 95% CI 1.13 to 2.36, p = 0.009, respectively). Nonetheless, in patients who underwent M-TEER post-TAVR, the cumulative 90-day all-cause hospitalization and heart failure hospitalization rates were less after M-TEER compared with before M-TEER (from 45.7% to 31.5%, p = 0.007, and from 29.0% to 16.6%, respectively, both p = 0.005). In conclusion, M-TEER procedures after TAVR in the United States are increasing. Patients with M-TEER after TAVR had similar in-hospital mortality as those who underwent M-TEER without recent TAVR, but higher 30-day hospitalization rates. Nonetheless, 90-day hospitalization rates were decreased after M-TEER in patients with previous TAVR.
经导管主动脉瓣置换术（TAVR）后持续性严重二尖瓣反流患者可能受益于经导管二尖瓣缘对缘修复术（M-TEER）。我们利用全国再入院数据库，确定了在 TAVR 后 6 个月内行 M-TEER 的患者，并将他们的结局与 2014 年至 2020 年同一日历年内无近期 TAVR 的患者进行比较。由于全国再入院数据库数据不跨年度，分析仅限于每个日历年度的下半年。终点包括院内死亡率和 30 天及 90 天出院后再入院率。在 23885 例 M-TEER 患者中，有 396 例（1.7%）有近期 TAVR。自 2014 年的 16 例，到 2020 年的 92 例，TAVR 后行 M-TEER 手术的例数逐渐增加。与无近期 TAVR 的患者相比，近期 TAVR 后行 M-TEER 的患者院内死亡率相似（校正比值比 0.38，95%置信区间[CI]为 0.12 至 1.23，p=0.11），但 30 天全因住院和心力衰竭住院的比例更高（校正比值比 1.34，95%CI 为 1.11 至 1.79，p=0.04 和 1.63，95%CI 为 1.13 至 2.36，p=0.009）。然而，在 TAVR 后行 M-TEER 的患者中，与 M-TEER 前相比，M-TEER 后 90 天全因住院和心力衰竭住院的累积发生率更低（从 45.7%降至 31.5%，p=0.007 和从 29.0%降至 16.6%，均为 p=0.005）。总之，美国 TAVR 后行 M-TEER 的手术例数正在增加。TAVR 后行 M-TEER 的患者院内死亡率与无近期 TAVR 行 M-TEER 的患者相似，但 30 天住院率更高。然而，在 TAVR 前接受 M-TEER 的患者中，M-TEER 后 90 天的住院率下降。
