Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Interventional Operation Room, The Affiliated Hospital of Qingdao University, Qingdao, China.
J Interv Cardiol. 2023 Oct 12;2023:4332684. doi: 10.1155/2023/4332684. eCollection 2023.
To study trends of utilization, in-hospital outcomes, and short outcomes in patients undergoing transcatheter mitral valve repair (TMVR) vs. surgical mitral valve repair (SMVR) in atrial fibrillation (AF).
TMVR is a treatment option in inoperable or high-risk patients with mitral regurgitation (MR). AF is a common comorbidity of MR. Data comparing between TMVR and SMVR in MR patients with AF is lacking.
The National Readmission Database from 2016 to 2019 was utilized to identify hospitalizations undergoing TMVR or SMVR with AF. Outcomes of interest included mortality, postoperative complications, length of stay, and 30-day readmission rate.
A total of 9,195 patients underwent TMVR and 16,972 patients underwent SMVR with AF; the number of AF undergoing TMVR was increasing from 1,342 in 2016 to 4,215 in 2019 and SMVR. The incidence of in-hospital mortality decreased from 2.6% in 2016 to 1.8% in 2019. We identified length of stay>5 days, dyslipidemia, cerebrovascular disease, heart failure with reduced ejection fraction, and urgent/emergent admissions as independent risk factors for in-hospital mortality. After matching, we included 4,680 patients in each group; the in-hospital death, transfusion, acute kidney injury, sepsis, stroke, and mechanical ventilation were lower in TMVR compared with SMVR. TMVR was associated with a similar rate of all-cause readmission at 30 days compared with SMVR.
Patients with AF receiving TMVR have been increasing along with progressive improvement in in-hospital death and length of stay. Compared to SMVR, AF patients receiving TMVR had a lower rate of in-hospital death and postoperative complications.
研究在房颤（AF）患者中，行经导管二尖瓣修复术（TMVR）与外科二尖瓣修复术（SMVR）的使用率、住院结局和短期结局的趋势。
TMVR 是二尖瓣反流（MR）不可手术或高危患者的一种治疗选择。AF 是 MR 的常见合并症。缺乏 TMVR 与 MR 合并 AF 患者的 SMVR 之间的数据比较。
利用 2016 年至 2019 年国家再入院数据库，确定接受 TMVR 或 SMVR 治疗合并 AF 的住院患者。感兴趣的结局包括死亡率、术后并发症、住院时间和 30 天再入院率。
共 9195 例患者接受 TMVR，16972 例患者接受 SMVR 合并 AF；接受 TMVR 的 AF 例数从 2016 年的 1342 例增加到 2019 年的 4215 例，而 SMVR 则有所减少。住院期间死亡率从 2016 年的 2.6%下降到 2019 年的 1.8%。我们确定住院时间超过 5 天、血脂异常、脑血管疾病、射血分数降低的心力衰竭和紧急/紧急入院是住院期间死亡的独立危险因素。匹配后，每组纳入 4680 例患者；TMVR 组的住院死亡、输血、急性肾损伤、败血症、中风和机械通气的发生率低于 SMVR 组。TMVR 与 SMVR 相比，30 天全因再入院率相似。
随着住院期间死亡率和住院时间的逐步改善，接受 TMVR 的 AF 患者数量不断增加。与 SMVR 相比，接受 TMVR 的 AF 患者的住院死亡率和术后并发症发生率较低。
