Center for Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany.
Inneren Medizin 3, Klinikum Mutterhaus der Borromäerinnen, Feldstr. 16, 54290, Trier, Germany.
Herz. 2024 Oct;49(5):371-377. doi: 10.1007/s00059-024-05245-2. Epub 2024 May 14.
Percutaneous valve therapies (PVT) are performed on a large number of patients. With increasing procedural volume, the need for follow-up has also increased. Follow-up in the heart valve clinic is endorsed by recent guidelines but utilization is unknown, making resource allocation in the clinic difficult. Central follow-up in valve centers may not be feasible for all patients in the future.
In our center, follow-up for PVT patients is scheduled at 1 month and 12 months after the index procedure. Patients are reminded of their appointment by invitation letters or phone calls. We analyzed 150 consecutive patients who underwent transcutaneous aortic valve implantation (TAVI) and MitraClip implantation (n = 300) at our center.
At 1 month, 72.7% of patients attended their follow-up, while at 12 months the rate dropped to 58%. Patients who underwent TAVI were older than the MitraClip patients (82.7 vs. 76.1 years) but had lower mean logEuroSCORE (22.6% vs. 25.9%). There was no significant difference in 1‑year mortality between TAVI and MitraClip patients (20% vs. 17.3%). By contrast, the rate of missed follow-up visits was higher for TAVI compared to MitraClip patients (52% vs. 33.3%; p = 0.002). Female patients less frequently attended follow-up (p = 0.005), whereas age, EuroSCORE, NYHA class, ejection fraction, and health status (EQ-5DVAS) were not predictors of attendance in multivariable analysis. Although the result of the EQ-5D assessment was not associated with mortality or attendance, completing the questionnaire was associated with overall survival (p < 0.001).
In our heart valve clinic, we observed a high percentage of missed follow-up appointments (42% at 12 months) despite a structured follow-up plan. Factors significantly associated with non-attendance in multivariable analysis were female gender and having a TAVI rather than MitraClip. Future follow-up concepts should take such findings into account, and decentralized approaches need to be explored.
经皮瓣膜治疗（PVT）在大量患者中进行。随着手术数量的增加，对随访的需求也增加了。心脏瓣膜门诊的随访得到了最近指南的认可，但利用情况尚不清楚，这使得门诊资源配置变得困难。未来，瓣膜中心可能无法为所有患者提供集中随访。
在我们中心，PVT 患者在索引手术后 1 个月和 12 个月进行随访。通过邀请函或电话提醒患者预约。我们分析了在我们中心接受经皮主动脉瓣植入术（TAVI）和 MitraClip 植入术（n=300）的 150 例连续患者。
在 1 个月时，72.7%的患者接受了随访，而在 12 个月时，这一比例降至 58%。接受 TAVI 的患者比接受 MitraClip 的患者年龄更大（82.7 岁比 76.1 岁），但平均 logEuroSCORE 较低（22.6%比 25.9%）。TAVI 和 MitraClip 患者的 1 年死亡率无显著差异（20%比 17.3%）。相比之下，TAVI 患者错过随访的比例高于 MitraClip 患者（52%比 33.3%；p=0.002）。女性患者较少接受随访（p=0.005），而年龄、EuroSCORE、NYHA 分级、射血分数和健康状况（EQ-5DVAS）在多变量分析中不是就诊的预测因素。尽管 EQ-5D 评估结果与死亡率或就诊率无关，但完成问卷与总生存率相关（p<0.001）。
在我们的心脏瓣膜门诊，尽管有一个结构化的随访计划，但我们观察到高比例的错过随访预约（12 个月时为 42%）。多变量分析中与就诊率显著相关的因素是女性和接受 TAVI 而不是 MitraClip。未来的随访概念应考虑到这些发现，并需要探索分散的方法。
