Hori Kentaro, Nakayama Atsuko, Tajima Shinya, Kanazawa Ruka, Hirakawa Kotaro, Adachi Yuichi, Izumi Yuki, Higuchi Ryosuke, Takamisawa Itaru, Nanasato Mamoru, Isobe Mitsuaki
Department of Rehabilitation, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu-shi, Tokyo, 183-0003, Japan.
Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
Heart Vessels. 2025 Apr 21. doi: 10.1007/s00380-025-02544-4.
Mitral regurgitation is a prevalent cardiac valvular disease, and its incidence is increasing with the aging population. While surgical intervention has traditionally been the standard treatment for this disease, in Japan, mitral transcatheter edge-to-edge repair (M-TEER) has emerged as a less invasive alternative since 2018. M-TEER demonstrates promising outcomes in reducing postoperative complications and shortening hospital stays. However, scarce data on cardiac rehabilitation (CR) following M-TEER is available. Therefore, in this study, we aimed to investigate the characteristics of CR progress during hospitalization and in-hospital outcomes following M-TEER. This single-center, retrospective cohort study involved 244 patients who underwent M-TEER at the Sakakibara Heart Institute between April 2018 and March 2023. Data on progress in CR and in-hospital outcomes, including hospitalization-associated disability (HAD), rate of return to home, and hospitalization that extended beyond 30 days after M-TEER, were collected. After excluding patients who met the exclusion criteria-including conversion to surgical mitral valve replacement or the absence of CR during hospitalization-233 patients were included in the analysis. The patients' median age was 81 years, with 48.5% being female. In 43% of cases, the hospitalizations were unplanned. Ambulation was initiated at a median of 1 day after M-TEER, with 88.4% of patients being able to commence ambulation as early as 2 days after M-TEER. However, only 19.3% engaged in aerobic exercise using equipment in the CR room. The median length of stay following M-TEER was 6 days, with 4.7% of hospitalizations resulting in a stay of 30 days or more. Ultimately, 90.6% of patients were discharged home, with an incidence of HAD of 9.9%. Compared to the planned hospitalization group, the unplanned hospitalization group had a significantly lower rate of early postoperative ambulation (planned hospitalization group: 97.7% vs. unplanned hospitalization group: 76.2%, p < 0.01), a higher proportion of patients with hospital stays exceeding 30 days (0% vs. 10.9%, p < 0.01), a lower rate of home discharge (98.5% vs. 80.2%, p < 0.01), and an increased incidence of HAD (0.8% vs. 22.2%, p < 0.01). M-TEER provides a minimally invasive treatment option for mitral regurgitation with favorable early rehabilitation and in-hospital outcomes, particularly in planned hospitalization. However, for unplanned hospitalizations, inpatient outcomes were poor.
二尖瓣反流是一种常见的心脏瓣膜疾病，其发病率随着人口老龄化而增加。传统上，手术干预一直是这种疾病的标准治疗方法，但在日本，自2018年以来，经导管二尖瓣缘对缘修复术（M-TEER）已成为一种侵入性较小的替代方法。M-TEER在减少术后并发症和缩短住院时间方面显示出良好的效果。然而，关于M-TEER术后心脏康复（CR）的数据却很少。因此，在本研究中，我们旨在调查M-TEER术后住院期间CR进展的特点以及院内结局。这项单中心回顾性队列研究纳入了2018年4月至2023年3月在酒匂心脏研究所接受M-TEER的244例患者。收集了CR进展和院内结局的数据，包括与住院相关的残疾（HAD）、回家率以及M-TEER术后超过30天的住院情况。在排除符合排除标准的患者（包括转为外科二尖瓣置换术或住院期间未进行CR）后，233例患者纳入分析。患者的中位年龄为81岁，女性占48.5%。43%的病例为非计划性住院。M-TEER术后中位1天开始活动，88.4%的患者最早在M-TEER术后2天就能开始活动。然而，只有19.3%的患者在CR室使用设备进行有氧运动。M-TEER术后的中位住院时间为6天，4.7%的住院患者住院时间达到30天或更长。最终，90.6%的患者出院回家，HAD发生率为9.9%。与计划性住院组相比，非计划性住院组术后早期活动率显著较低（计划性住院组：97.7% vs.非计划性住院组：76.2%，p<0.01），住院时间超过30天的患者比例更高（0% vs. 10.9%，p<0.01），回家出院率更低（98.5% vs. 80.2%，p<0.01），HAD发生率更高（0.8% vs. 22.2%，p<0.01）。M-TEER为二尖瓣反流提供了一种微创治疗选择，具有良好的早期康复和院内结局，尤其是在计划性住院的情况下。然而，对于非计划性住院，住院结局较差。
