Torres Christian, Lozier Mathew R, Davidson Charles J, Ailawadi Gorav, Donatelle Marissa, Vedantam Karthik, Kodali Susheel K, Leon Martin B, Beohar Nirat
Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida.
Bluhm Cardiovascular Institute, Northwestern University Division of Cardiology, Chicago, Illinois.
J Soc Cardiovasc Angiogr Interv. 2022 Aug 4;1(5):100414. doi: 10.1016/j.jscai.2022.100414. eCollection 2022 Sep-Oct.
Patients with severe tricuspid regurgitation carry an elevated surgical risk resulting in increasing adoption of less invasive transcatheter therapies such as transcatheter tricuspid valve repair (TTVR); however, data are limited. This study aimed to describe patient characteristics and predictors of poor outcomes among those undergoing TTVR.
The National Inpatient Sample was queried (2016-2019) to identify all patients undergoing TTVR ( code 02UJ3JZ) alone or in combination with mitral transcatheter edge-to-edge repair (MTEER) (code 02UG3JZ). The primary aim was to define clinical characteristics, time trends, in-hospital outcomes, and predictors of all-cause in-hospital mortality (mortality). The secondary outcomes included predictors of increased hospitalization costs and length of stay (greater than the 75th percentile).
We identified 925 patients who underwent TTVR (460 [49.7%] who underwent TTVR alone and 465 [50.3%] who underwent TTVR in combination with MTEER). There was a 6.5-fold increase in TTVR adoption ( < .001). Patients were older (78 ± 10 years), female (63.2%), and White (72.7%), with frequent comorbidities. Mortality occurred in 2.2%, vascular complications occurred in 10.3%, and major bleeding occurred in 3.3%. The predictors of mortality were acute kidney injury (odds ratio [OR], 5.25; 95% CI, 5.24-5.26; < .001), major bleeding (OR, 2.81; 95% CI, 2.80-2.83; < .001), pericardiocentesis (OR, 2.15; 95% CI, 2.11-2.18; < .001), and chronic liver disease (OR, 1.40; 95% CI, 1.39-1.40; < .001). The predictors of increased length of stay or hospitalization costs included coronary artery disease, atrial arrhythmias, pulmonary hypertension, chronic liver disease, and procedural complications.
TTVR showed increased adoption with elevated but acceptable mortality and complications considering this high-risk population. The results of randomized trials are awaited.
重度三尖瓣反流患者手术风险较高，这使得诸如经导管三尖瓣修复术（TTVR）等侵入性较小的治疗方法越来越多地被采用；然而，相关数据有限。本研究旨在描述接受TTVR患者的特征及预后不良的预测因素。
查询国家住院患者样本（2016 - 2019年），以确定所有单独接受TTVR（代码02UJ3JZ）或与二尖瓣经导管缘对缘修复术（MTEER，代码02UG3JZ）联合接受TTVR的患者。主要目的是明确临床特征、时间趋势、住院结局以及全因住院死亡率（死亡率）的预测因素。次要结局包括住院费用增加和住院时间延长（大于第75百分位数）的预测因素。
我们确定了925例接受TTVR的患者（460例[49.7%]单独接受TTVR，465例[50.3%]接受TTVR联合MTEER）。TTVR的采用率增加了6.5倍（P <.001）。患者年龄较大（78±10岁），女性占63.2%，白人占72.7%，且常伴有多种合并症。死亡率为2.2%，血管并发症发生率为10.3%，大出血发生率为3.3%。死亡率的预测因素包括急性肾损伤（比值比[OR]，5.25；95%置信区间[CI]，5.24 - 5.26；P <.001）、大出血（OR，2.81；95% CI，2.80 - 2.83；P <.001）、心包穿刺术（OR，2.15；95% CI，2.11 - 2.18；P <.001）和慢性肝病（OR，1.40；95% CI，1.39 - 1.40；P <.001）。住院时间延长或住院费用增加的预测因素包括冠状动脉疾病、房性心律失常、肺动脉高压、慢性肝病和手术并发症。
考虑到这一高危人群，TTVR的采用率有所增加，死亡率和并发症虽有所上升但仍可接受。期待随机试验的结果。
