Ashraf Muddasir, Allaqaband Suhail Q, Ammar Khawaja Afzal, Jain Renuka, Harland Daniel R, Zubair Haroon, Sherry Charnai, Bajwa Tanvir
Department of Aurora Cardiovascular and Thoracic Services, Aurora St. Luke's Medical Center, Aurora Health Care, Milwaukee, Wisconsin.
Aurora Sinai Medical Center, Aurora Health Care, Milwaukee, Wisconsin.
J Soc Cardiovasc Angiogr Interv. 2025 Jul 23;4(8):103785. doi: 10.1016/j.jscai.2025.103785. eCollection 2025 Aug.
Data are limited on outcomes of elective vs nonelective mitral transcatheter edge-to-edge repair (M-TEER).
Using the National Inpatient Sample, all adult patients who had M-TEER from 2013-2020 were included in the study. Univariate and multivariate linear and logistic regression were used to evaluate outcomes.
Of 43,920 patients who underwent M-TEER, with a mean age (SE) of 77 (0.13) years, 46% were women. Of these, 23% were nonelective, and 77% were elective cases. Whites were more likely to have elective, and African Americans and Hispanics were more likely to have nonelective M-TEER. In-hospital mortality and resource utilization decreased over time in elective cases, but no significant change was seen in nonelective cases. Risk-adjusted odds of in-hospital mortality were higher in nonelective vs elective cases (adjusted odds ratio, 2.85; < .001). Risk-adjusted length of stay was also higher in nonelective vs elective cases (adjusted beta-coefficient, 7.16; < .001). Finally, the risk-adjusted inflation-adjusted cost was also higher in nonelective vs elective cases (adjusted beta-coefficient, 23,673; < .001).
Nonelective M-TEER is associated with poor outcomes. Hence, these patients should be treated in a timely fashion and should not be deferred if they meet the criteria for M-TEER. Rapid up-titration of guideline-directed medical therapy should be considered in patients with moderate to severe secondary mitral regurgitation to avoid an emergent need for transcatheter edge-to-edge repair and associated poor outcomes.
关于选择性与非选择性二尖瓣经导管缘对缘修复术（M-TEER）的结果数据有限。
利用全国住院患者样本，纳入2013年至2020年期间接受M-TEER的所有成年患者。采用单因素和多因素线性及逻辑回归来评估结果。
在43920例接受M-TEER的患者中，平均年龄（标准误）为77（0.13）岁，46%为女性。其中，23%为非选择性病例，77%为选择性病例。白人更有可能接受选择性手术，非裔美国人和西班牙裔更有可能接受非选择性M-TEER。选择性病例的住院死亡率和资源利用率随时间下降，但非选择性病例未见显著变化。非选择性病例的住院死亡风险调整比值高于选择性病例（调整后的比值比为2.85；P<0.001）。非选择性病例的风险调整住院时间也高于选择性病例（调整后的β系数为7.16；P<0.001）。最后，非选择性病例的风险调整通胀调整成本也高于选择性病例（调整后的β系数为23673；P<0.001）。
非选择性M-TEER与不良结果相关。因此，这些患者应及时接受治疗，如果符合M-TEER标准，不应推迟治疗。对于中重度继发性二尖瓣反流患者，应考虑迅速加强指南指导的药物治疗，以避免紧急需要经导管缘对缘修复术及相关不良结果。
