Ahmed Asmaa, Eisa Mahmoud, Takla Andrew, Arora Sahej, Mohamed Mohamed Salah, Hanafi Amir, Feitell Scott
Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.
Department of Internal Medicine, Unity Hospital, Rochester, NY, USA.
Future Cardiol. 2025 Jan;21(1):15-22. doi: 10.1080/14796678.2024.2442238. Epub 2024 Dec 23.
Mitral Valve Transcatheter Edge-to-Edge Repair (M-TEER) is a minimally invasive procedure for patients with symptomatic mitral regurgitation. Its outcomes in patients with a history of coronary artery bypass grafting (CABG) remain unclear.
We analyzed data from the Nationwide Inpatient Sample, using ICD-10-CM codes for M-TEER and CABG. Primary outcomes included in-hospital all-cause mortality and periprocedural cardiac complications. Inverse probability of treatment weighting was employed to compare M-TEER patients with or without prior CABG.
From January 2016 to December 2020, we identified 48,835 M-TEER cases in the U.S. with 9,655 patients (19.78%) having a prior CABG. These patients were older and had more comorbidities. M-TEER procedures increased over the study period, including those with prior CABG (2,145 in 2016 vs. 2,682 in 2020). Adjusted analysis showed no significant difference in in-hospital mortality between patients with and without prior CABG [adjusted odds ratio (aOR) 0.85, 95% confidence interval (CI) 0.85-1.32, = 0.47]. However, patients with prior CABG had lower odds of periprocedural cardiac complications [aOR 0.72, 95% CI 0.59-0.87, = 0.001].
M-TEER appears safe for patients with prior CABG, showing no adverse peri-procedural outcomes compared to those without CABG. Despite more comorbidities, M-TEER remains a safe option for these patients.
二尖瓣经导管缘对缘修复术（M-TEER）是一种针对有症状二尖瓣反流患者的微创手术。其在有冠状动脉旁路移植术（CABG）病史患者中的疗效仍不明确。
我们使用M-TEER和CABG的国际疾病分类第十次修订本临床修正版（ICD-10-CM）编码分析了全国住院患者样本数据。主要结局包括院内全因死亡率和围手术期心脏并发症。采用治疗权重的逆概率方法比较有或无既往CABG的M-TEER患者。
2016年1月至2020年12月，我们在美国识别出48,835例M-TEER病例，其中9,655例患者（19.78%）有既往CABG病史。这些患者年龄更大，合并症更多。在研究期间，M-TEER手术量有所增加，包括有既往CABG的患者（2016年为2,145例，2020年为2,682例）。校正分析显示，有或无既往CABG的患者院内死亡率无显著差异[校正比值比（aOR）为0.85，95%置信区间（CI）为0.85 - 1.32，P = 0.47]。然而，有既往CABG的患者围手术期心脏并发症的发生率较低[aOR为0.72，95% CI为0.59 - 0.87，P = 0.001]。
对于有既往CABG病史的患者，M-TEER似乎是安全的，与无CABG病史的患者相比，围手术期未显示不良结局。尽管合并症更多，但M-TEER对这些患者而言仍是一个安全的选择。
