Association of Transcatheter Mitral Valve Repair Availability With Outcomes of Mitral Valve Surgery
Background Transcatheter mitral valve repair (TMVr) is currently offered at selected centers that meet certain operator and institutional requirements. We sought to explore the hypothesis that the availability of TMVr is associated with improved outcomes of MV surgery. Methods and Results We used th...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.019314 |
| _version_ | 1818315152575954944 |
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| author | Mohamad Alkhouli Fahad Alqahtani Akram Kawsara Mayra Guerrero Mackram F. Eleid Vuyisile T. Nkomo Charanjit S. Rihal Juan A. Crestanello |
| author_facet | Mohamad Alkhouli Fahad Alqahtani Akram Kawsara Mayra Guerrero Mackram F. Eleid Vuyisile T. Nkomo Charanjit S. Rihal Juan A. Crestanello |
| author_sort | Mohamad Alkhouli |
| collection | DOAJ |
| description | Background Transcatheter mitral valve repair (TMVr) is currently offered at selected centers that meet certain operator and institutional requirements. We sought to explore the hypothesis that the availability of TMVr is associated with improved outcomes of MV surgery. Methods and Results We used the Nationwide Readmissions Database to identify patients who underwent MV surgery at centers with or without TMVr capabilities between January 1 and December 31, 2017. The primary end point was in‐hospital mortality. Secondary end points were postoperative complications, resource use, and 30‐day readmissions. A total of 24 477 patients from 595 centers (446 TMVr, 149 non‐TMVr) were included. There were modest but statistically significant differences in the prevalence of comorbidities between the groups. Patients at non‐TMVr centers had higher unadjusted in‐hospital mortality than those at TMVr centers (5.6% versus 3.6%, P<0.001). They also had higher rates of postoperative complications, longer hospitalizations, higher cost, and fewer home discharges but similar 30‐day readmission rates. After propensity matching, mortality remained higher at non‐TMVr centers (5.5% versus 4.0%, P<0.001). Rates of postoperative complications, prolonged hospitalizations, and nonhome discharges also remained higher. Postoperative mortality was consistently higher at non‐TMVr centers in multiple risk‐adjustment analyses incrementally accounting for differences in risk factors, surgical volume, availability of surgical repair, and excluding concomitant procedures. In the most comprehensive model, surgery at non‐TMVr centers was associated with higher odds of death (odds ratio, 1.41; 95% CI, 1.14–1.73; P=0.002). Conclusions Mitral valve surgery at TMVr centers is associated with improved in‐hospital outcomes compared with non‐TMVr centers. |
| first_indexed | 2024-12-13T09:01:00Z |
| format | Article |
| id | doaj.art-c23e1e7633fd420a84f592c5fce884cd |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T09:01:00Z |
| publishDate | 2021-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-c23e1e7633fd420a84f592c5fce884cd2022-12-21T23:53:10ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-04-0110710.1161/JAHA.120.019314Association of Transcatheter Mitral Valve Repair Availability With Outcomes of Mitral Valve SurgeryMohamad Alkhouli0Fahad Alqahtani1Akram Kawsara2Mayra Guerrero3Mackram F. Eleid4Vuyisile T. Nkomo5Charanjit S. Rihal6Juan A. Crestanello7Department of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDivision of Cardiology Department of Medicine West Virginia University Morgantown WVDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Medicine Mayo Clinic Rochester MNDepartment of Cardiovascular Surgery Mayo Clinic School of Medicine Rochester MNBackground Transcatheter mitral valve repair (TMVr) is currently offered at selected centers that meet certain operator and institutional requirements. We sought to explore the hypothesis that the availability of TMVr is associated with improved outcomes of MV surgery. Methods and Results We used the Nationwide Readmissions Database to identify patients who underwent MV surgery at centers with or without TMVr capabilities between January 1 and December 31, 2017. The primary end point was in‐hospital mortality. Secondary end points were postoperative complications, resource use, and 30‐day readmissions. A total of 24 477 patients from 595 centers (446 TMVr, 149 non‐TMVr) were included. There were modest but statistically significant differences in the prevalence of comorbidities between the groups. Patients at non‐TMVr centers had higher unadjusted in‐hospital mortality than those at TMVr centers (5.6% versus 3.6%, P<0.001). They also had higher rates of postoperative complications, longer hospitalizations, higher cost, and fewer home discharges but similar 30‐day readmission rates. After propensity matching, mortality remained higher at non‐TMVr centers (5.5% versus 4.0%, P<0.001). Rates of postoperative complications, prolonged hospitalizations, and nonhome discharges also remained higher. Postoperative mortality was consistently higher at non‐TMVr centers in multiple risk‐adjustment analyses incrementally accounting for differences in risk factors, surgical volume, availability of surgical repair, and excluding concomitant procedures. In the most comprehensive model, surgery at non‐TMVr centers was associated with higher odds of death (odds ratio, 1.41; 95% CI, 1.14–1.73; P=0.002). Conclusions Mitral valve surgery at TMVr centers is associated with improved in‐hospital outcomes compared with non‐TMVr centers.https://www.ahajournals.org/doi/10.1161/JAHA.120.019314mitral regurgitationmitral valve surgerytranscatheter mitral valve repair |
| spellingShingle | Mohamad Alkhouli Fahad Alqahtani Akram Kawsara Mayra Guerrero Mackram F. Eleid Vuyisile T. Nkomo Charanjit S. Rihal Juan A. Crestanello Association of Transcatheter Mitral Valve Repair Availability With Outcomes of Mitral Valve Surgery Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease mitral regurgitation mitral valve surgery transcatheter mitral valve repair |
| title | Association of Transcatheter Mitral Valve Repair Availability With Outcomes of Mitral Valve Surgery |
| title_full | Association of Transcatheter Mitral Valve Repair Availability With Outcomes of Mitral Valve Surgery |
| title_fullStr | Association of Transcatheter Mitral Valve Repair Availability With Outcomes of Mitral Valve Surgery |
| title_full_unstemmed | Association of Transcatheter Mitral Valve Repair Availability With Outcomes of Mitral Valve Surgery |
| title_short | Association of Transcatheter Mitral Valve Repair Availability With Outcomes of Mitral Valve Surgery |
| title_sort | association of transcatheter mitral valve repair availability with outcomes of mitral valve surgery |
| topic | mitral regurgitation mitral valve surgery transcatheter mitral valve repair |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.019314 |
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