Bansal Kannu, Rawlley Bharat, Majmundar Vidit, Beale Robert, Shah Miloni, Kosinski Andrzej S, Gupta Tanush, Gilani Fahad, Anwaruddin Saif, Khera Sahil, Vemulapalli Sreekanth, Elmariah Sammy, Kolte Dhaval
Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA.
Department of Internal Medicine, SUNY Upstate Medical Center, Syracuse, New York, USA.
JACC Cardiovasc Interv. 2025 Apr 14;18(7):882-894. doi: 10.1016/j.jcin.2025.01.425. Epub 2025 Feb 25.
Transcatheter edge-to-edge repair of mitral valve (mTEER) is increasingly being adopted, with improved outcomes. However, it remains crucial to evaluate short-term out-of-hospital mortality to elucidate areas for further improvement.
The authors sought to evaluate incidence and predictors of out-of-hospital 30-day mortality after mTEER.
We used the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry to identify patients who underwent mTEER between January 2014 and April 2023. Primary and secondary outcomes were 30-day out-of-hospital all-cause and cardiovascular mortality, respectively. Logistic regression and survival analysis models were used to identify factors associated with these outcomes.
Of 61,139 patients who underwent mTEER, 1,813 (3.0%) died within 30 days of the procedure. Of these, 744 (41.0%) died out-of-hospital after discharge. Cardiovascular causes accounted for 63.4% of out-of-hospital mortality at 30 days. The median time from discharge to 30-day out-of-hospital all-cause mortality was 11 (Q1-Q3: 5-19) days. Older age, White race, non-Hispanic ethnicity, lower baseline hemoglobin, poor baseline health status, presentation as non-ST-segment elevation myocardial infarction, lower left ventricular ejection fraction, higher acuity presentation, in-hospital complications, ≥moderate residual mitral regurgitation, and lack of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge were independently associated with higher 30-day out-of-hospital all-cause and cardiovascular mortality.
Although overall 30-day all-cause mortality after mTEER was low, 2 of 5 deaths occurred out-of-hospital after discharge. Multiple modifiable factors such as patient selection, guideline-directed medical therapy underutilization and procedural complications require optimization to mitigate out-of-hospital mortality after mTEER.
二尖瓣经导管缘对缘修复术（mTEER）的应用越来越广泛，手术效果也有所改善。然而，评估短期院外死亡率对于明确进一步改进的方向仍然至关重要。
作者旨在评估mTEER术后30天院外死亡率的发生率及预测因素。
我们使用胸外科医师协会/美国心脏病学会经导管瓣膜治疗注册中心的数据，确定2014年1月至2023年4月期间接受mTEER的患者。主要和次要结局分别为30天院外全因死亡率和心血管死亡率。采用逻辑回归和生存分析模型确定与这些结局相关的因素。
在61139例接受mTEER的患者中，1813例（3.0%）在术后30天内死亡。其中，744例（41.0%）在出院后死于院外。心血管原因占30天院外死亡率的63.4%。从出院到30天院外全因死亡的中位时间为11天（第一四分位数-第三四分位数：5-19天）。年龄较大、白人种族、非西班牙裔、基线血红蛋白水平较低、基线健康状况较差、表现为非ST段抬高型心肌梗死、左心室射血分数较低、病情较重、住院并发症、≥中度二尖瓣反流残留以及出院时未使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂与30天院外全因和心血管死亡率较高独立相关。
尽管mTEER术后30天全因死亡率总体较低，但五分之二的死亡发生在出院后的院外。患者选择、指南指导的药物治疗未充分利用和手术并发症等多个可改变因素需要优化，以降低mTEER术后的院外死亡率。
