一项全国范围内二尖瓣经导管边缘到边缘修复患者的资源利用和安全性分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-05-10 DOI:10.1016/j.ijcha.2025.101696

Tharusan Thevathasan , Sophie Berlinghof , Daniel Elschenbroich , Julia M. Wiedenhofer , Sêhnou Degbeon , Luise Holzhauser , Fabian Barbieri , Mario Kasner , Anna Brand , Henryk Dreger , Steffen Desch , Ulf Landmesser , Markus Reinthaler , Carsten Skurk

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引用次数: 0

摘要

经导管边缘到边缘修复（TEER）治疗二尖瓣反流的研究进展迅速。MitraClip®系统在2016年至2019年（第二代至第四代）期间进行了逐步改进。然而，关于围手术期结果的真实数据仍然有限。我们分析了2016年至2019年美国使用MitraClip®系统的TEER的围手术期医疗资源利用率和安全性。方法主要结局指标（医疗资源利用）包括住院时间（LOS）、短期医院或专业护理机构不良出院和住院费用。次要结局（安全性）是住院死亡率和术后并发症。结果5212名成人接受了二尖瓣TEER检查。平均年龄77.7（±10.1）岁；年龄超过75岁的3645例（69.9%）。Charlson合并症指数中位数为3 [IQR 1-4]，心血管危险因素数为3 [2 - 4]，CHA2DS2-VASc评分为4[3 - 5]，简化后的ha - bled评分为2[2 - 3]。大多数手术在大型医院（76.0%）和美国海岸的区域中心进行。在2016年至2019年期间，LOS下降了21% (95% CI 0.79-0.85)，不良出院率下降了41% (95% CI 0.45-0.78)，住院费用下降了8% （95% CI 0.88-0.95）。TEER表现出良好的安全性：血管并发症、缺血性卒中、心脏骤停和心包填塞各占1%；死亡率1.6%，出血3.3%，心源性休克4.5%。复合安全性结果下降了27% （95% CI 0.59-0.91）。所有不良结局均随合并症负担的增加而线性增加(P表示趋势<；0.001)。结论由于技术的进步、操作人员的经验和集中护理，二尖瓣TEER已变得更加安全、高效。高度合并症患者应谨慎。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

A nationwide analysis of resource utilization and safety in patients undergoing mitral transcatheter edge-to-edge repair

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A nationwide analysis of resource utilization and safety in patients undergoing mitral transcatheter edge-to-edge repair

Background

Transcatheter edge-to-edge repair (TEER) for mitral regurgitation has rapidly progressed. The MitraClip® system underwent stepwise improvements between 2016 and 2019 (second to fourth generation). However, real-world data on peri-procedural outcomes remain limited. We analyzed peri-procedural healthcare resource utilization and safety of TEER with the MitraClip® system in the U.S. between 2016 and 2019.

Methods

Primary outcomes (healthcare resource utilization) included hospital length of stay (LOS), adverse discharge to a short-term hospital or skilled nursing facility and hospital costs. Secondary outcomes (safety) were in-hospital mortality and post-procedural complications.

Results

A total of 5,212 adults underwent mitral TEER. Mean age was 77.7 (±10.1) years; 3,645 patients (69.9 %) were over 75 years. Median Charlson Comorbidity Index was 3 [IQR 1–4], number of cardiovascular risk factors 3 [2–4], CHA₂DS₂-VASc score 4 [3–5] and simplified HAS-BLED score 2 [2–3]. Most procedures were performed at large hospitals (76.0 %) and regional hubs on both U.S. coasts. Between 2016 and 2019, LOS decreased by 21 % (95 % CI 0.79–0.85), adverse discharges by 41 % (95 % CI 0.45–0.78) and hospital costs by 8 % (95 % CI 0.88–0.95). TEER showed favorable safety: vascular complications, ischemic strokes, cardiac arrests and tamponades each <1 %; mortality 1.6 %, bleeding 3.3 % and cardiogenic shock 4.5 %. The composite safety outcome declined by 27 % (95 % CI 0.59–0.91). All adverse outcomes increased linearly with increasing comorbidity burden (P for trend < 0.001).

Conclusion

Mitral TEER has become safer and more efficient due to technological advances, operator experience and centralized care. Caution is advised in highly comorbid patients.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.