Temporal Changes in Procedural Success and Clinical Outcomes of MTEER by Mechanism of MR: Analysis of the STS/TVT Registry.

IF 6.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Zach Rozenbaum, Sreekanth Vemulapalli, Miloni Shah, Andrzej Stanislaw Kosinski, Eric Gnall
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引用次数: 0

Abstract

Background: With the expansion of indications for mitral transcatheter edge-to-edge repair into nondegenerative etiologies, it is unknown whether changes in technical success and clinical outcomes have occurred.

Methods: The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (STS/TVT) registry was analyzed from 2013 to 2023. Patients in shock were excluded. Patients were grouped by the mechanism of mitral regurgitation (MR) and divided into time periods.

Results: Overall, 68 028 patients were included. The application of mitral transcatheter edge-to-edge repair has evolved over the past decade to include more nondegenerative etiologies-increasing from 19% to 43%. The biggest growth was observed in functional MR (atrial and ventricular). Excluding acute ischemic MR, the odds of technical success were significantly higher for all mechanisms compared with degenerative MR (DMR). Over time more procedures were performed using only 1 implanted device (64.7% during 2022-2023 versus 54.6% during 2013-2017), without negatively impacting technical success. In multivariable analyses, the risk of 1-year heart failure readmission for ventricular functional MR was not higher than for DMR (P=0.10642), while patients with chronic ischemic MR and atrial MR had a 19% higher risk of 1-year heart failure readmission compared with DMR (P=0.00493) even if they had a successful procedure. However, the risk of 1-year mortality was not higher in nondegenerative etiologies compared with DMR. There was no statistically significant interaction between MR mechanism and time in outcomes analyses, indicating that the effect of MR mechanism on the technical and 1-year clinical outcomes did not vary significantly over time.

Conclusions: The application of mitral transcatheter edge-to-edge repair for nondegenerative etiologies increased considerably. While the odds of technical success were higher for all etiologies except acute ischemic MR, a similar 1-year mortality risk was observed in nondegenerative etiologies compared with DMR in real-world settings. These data support the use of mitral transcatheter edge-to-edge repair in degenerative and nondegenerative etiologies.

按 MR 机制划分的 MTEER 手术成功率和临床结果的时间变化:STS/TVT 登记分析。
背景:随着二尖瓣经导管边缘到边缘修复的适应症扩展到非退行性病因,尚不清楚技术成功和临床结果是否发生了变化。方法:对2013 - 2023年胸外科学会/美国心脏病学会经导管瓣膜治疗(STS/TVT)注册表进行分析。排除休克患者。根据二尖瓣反流(MR)机制对患者进行分组,并按时间段进行分组。结果:共纳入68028例患者。在过去的十年中,二尖瓣经导管边缘到边缘修复的应用已经发展到包括更多的非退行性病因,从19%增加到43%。功能性MR(心房和心室)增长最大。除急性缺血性MR外,与退行性MR (DMR)相比,所有机制的技术成功几率都明显更高。随着时间的推移,更多的手术只使用一个植入装置(2022-2023年为64.7%,2013-2017年为54.6%),没有对技术成功产生负面影响。在多变量分析中,心室功能性MR患者1年心力衰竭再入院的风险不高于DMR患者(P=0.10642),而慢性缺血性MR和心房MR患者1年心力衰竭再入院的风险比DMR患者高19% (P=0.00493),即使他们手术成功。然而,与DMR相比,非退行性病因的1年死亡率风险并不高。结果分析中,MR机制和时间之间没有统计学意义上的相互作用,表明MR机制对技术和1年临床结果的影响没有随时间发生显著变化。结论:二尖瓣经导管边缘到边缘修复在非退行性病因中的应用显著增加。虽然除急性缺血性MR外,所有病因的技术成功几率都较高,但与现实环境中的DMR相比,非退行性病因的1年死亡率风险相似。这些数据支持二尖瓣经导管边缘到边缘修复在退行性和非退行性病因中的应用。
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来源期刊
Circulation: Cardiovascular Interventions
Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
1.80%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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