Gröger Matthias, Felbel Dominik, Paukovitsch Michael, Schneider Leonhard Moritz, Markovic Sinisa, Rottbauer Wolfgang, Keßler Mirjam
Department of Internal Medicine II, Ulm University Heart Center, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Clin Res Cardiol. 2025 Jul;114(7):818-826. doi: 10.1007/s00392-024-02384-8. Epub 2024 Feb 14.
Transcatheter edge-to-edge mitral valve repair (M-TEER) is often performed in general anesthesia, and postprocedural monitoring is usually warranted on an intensive or intermediate care unit (ICU/IMC). We evaluated the implications of a dedicated valve unit (VU) instead of an ICU/IMC for monitoring after M-TEER.
In total, 624 patients were retrospectively analyzed. A total of 312 patients were primarily transferred to either ICU or IMC following M-TEER, and 312 patients were scheduled for the VU in the absence of indications for ICU/IMC treatment. Hospital stay was significantly shorter in VU patients (median 6.0 days (interquartile range (IQR) 5.0 - 8.0) vs. 7.0 days (IQR 6.0 - 10.0), p < 0.001) and their risk for infections (2.9 vs. 7.7%, p = 0.008) and delirium (0.6 vs. 2.6%, p = 0.056) was substantially lower compared to ICU/IMC patients. In-hospital mortality was similar in both groups (0.6% vs. 1.3%, p = 0.41). Fifty patients (16.0%) in the VU group had to cross over to unplanned ICU/IMC admission. The most frequent indication was prolonged need for catecholamines (52.0%). Patients with ICU/IMC crossover had more advanced stages of heart failure (LV-EF < 30% in 36.0 vs. 16.0%, p = 0.001; severe concomitant tricuspid regurgitation in 48.0 vs. 27.8%, p = 0.005) and an LV-EF < 30% was independently associated with unplanned ICU/IMC admission.
Following M-TEER postprocedural monitoring on a VU instead of an ICU/IMC is safe, reduces complications, and spares ICU capacities. Patients with advanced heart failure have a higher risk for unplanned ICU/IMC treatment after M-TEER.
经导管二尖瓣缘对缘修复术（M-TEER）通常在全身麻醉下进行，术后监测通常需要在重症监护病房或中级护理病房（ICU/IMC）进行。我们评估了用专门的瓣膜病房（VU）代替ICU/IMC进行M-TEER术后监测的影响。
总共对624例患者进行了回顾性分析。共有312例患者在M-TEER术后主要被转入ICU或IMC，312例患者在没有ICU/IMC治疗指征的情况下被安排进入VU。VU组患者的住院时间明显更短（中位数6.0天（四分位间距（IQR）5.0 - 8.0） vs. 7.0天（IQR 6.0 - 10.0），p < 0.001），与ICU/IMC组患者相比，其感染风险（2.9% vs. 7.7%，p = 0.008）和谵妄风险（0.6% vs. 2.6%，p = 0.056）显著更低。两组的院内死亡率相似（0.6% vs. 1.3%，p = 0.41）。VU组中有50例患者（16.0%）不得不转为非计划的ICU/IMC入院。最常见的指征是对儿茶酚胺的需求延长（52.0%）。转为ICU/IMC的患者心力衰竭的阶段更严重（左心室射血分数<30%的比例为36.0% vs. 16.0%，p = 0.001；重度合并三尖瓣反流的比例为48.0% vs. 27.8%，p = 0.005），且左心室射血分数<30%与非计划的ICU/IMC入院独立相关。
M-TEER术后在VU而非ICU/IMC进行监测是安全的，可减少并发症，并节省ICU资源。心力衰竭晚期患者在M-TEER术后接受非计划ICU/IMC治疗的风险更高。
