Dokollari Aleksander, Sicouri Serge, Rodriguez Roberto, Gnall Eric, Coady Paul, Mahmud Farah, Kjelstrom Stephanie, Montone Georgia, Yamashita Yoshiyuki, Harish Jarrett, Bacchi Beatrice, Arora Rakesh C, Shah Ashish, Ghorpade Nitin, Abramson Sandra, Hawthorne Katie, Goldman Scott, Gray William, Cabrucci Francesco, Bonacchi Massimo, Ramlawi Basel
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA 19096, USA.
Cardiac Surgery Division, St. Boniface Hospital, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
J Pers Med. 2024 Sep 15;14(9):978. doi: 10.3390/jpm14090978.
To analyze the clinical and cost outcomes of transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) in heart failure (HF) patients. All 162 HF patients undergoing TEER for MR between January 2019 and March 2023 were included. A propensity-adjusted analysis was used to compare 32 systolic vs. 97 diastolic vs. 33 mixed (systolic + diastolic) HF patients. Systolic, diastolic, and mixed HF patients were defined according to AHA guidelines. The primary outcome was the long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs, all-cause mortality + stroke + myocardial infarction + repeat intervention). The mean age was 76.3 vs. 80.9 vs. 76 years old, and the mean ejection fraction (EF) was 39.5% vs. 59.8% vs. 39.7% in systolic vs. diastolic vs. mixed HF, respectively. Postoperatively, the diastolic vs. systolic HF group had a higher intensive care unit stay (21 vs. 0 h; HR 67.5 (23.7, 111.4)]; lower ventilation time [2 vs. 2.3 h; HR 49.4 (8.6, 90.2)]; lower EF [38% vs. 58.5%; HR 9.9 (3.7, 16.1)]. In addition, the diastolic vs. mixed HF groups had a lower incidence of EF < 50% (11 vs. 27 patients; HR 6.6 (1.6, 27.3) and a lower use of dialysis (one vs. three patients; HR 18.1 (1.1, 287.3), respectively. At a mean 1.6 years follow-up, all-cause death [HR 39.8 (26.2, 60.5)], MACCEs [HR 50.3 (33.7-75.1)], and new pacemaker implantations [HR 17.3 (8.7, 34.6)] were higher in the mixed group. There was no significant total hospital cost difference among the systolic (USD 106,859) vs. diastolic (USD 91,731) vs. mixed (USD 120,522) HF groups ( = 0.08). TEER for MR evidenced the worst postoperative and follow-up clinical outcomes in the mixed HF group compared to diastolic and systolic HF groups. No total hospital cost differences were observed.
分析经导管缘对缘修复术（TEER）治疗心力衰竭（HF）患者二尖瓣反流（MR）的临床和成本结果。纳入了2019年1月至2023年3月期间接受TEER治疗MR的所有162例HF患者。采用倾向调整分析比较32例收缩性HF患者、97例舒张性HF患者和33例混合性（收缩性+舒张性）HF患者。收缩性、舒张性和混合性HF患者根据美国心脏协会（AHA）指南进行定义。主要结局是全因死亡和主要不良心血管和脑血管事件（MACCEs，全因死亡率+中风+心肌梗死+再次干预）的长期发生率。收缩性HF、舒张性HF和混合性HF患者的平均年龄分别为76.3岁、80.9岁和76岁，平均射血分数（EF）分别为39.5%、59.8%和39.7%。术后，舒张性HF组与收缩性HF组相比，重症监护病房住院时间更长（21小时对0小时；风险比[HR]67.5[23.7，111.4]）；通气时间更短（2小时对2.3小时；HR49.4[8.6，90.2]）；EF更低（38%对58.5%；HR9.9[3.7，16.1]）。此外，舒张性HF组与混合性HF组相比，EF< 50%的发生率更低（11例对27例患者；HR 6.6[1.6，27.3]），透析使用率更低（1例对3例患者；HR18.1[1.1，287.3]）。在平均随访1.6年时，混合组的全因死亡[HR39.8（26.2，60.5）]、MACCEs[HR50.3（33.7 - 75.1）]和新起搏器植入率[HR17.3（8.7，34.6）]更高。收缩性HF组（106,859美元）、舒张性HF组（91,731美元）和混合性HF组（120,522美元）之间的总住院费用无显著差异（P = 0.08）。与舒张性和收缩性HF组相比，混合性HF组的MR经TEER治疗后术后及随访临床结局最差。未观察到总住院费用差异。
