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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Transcatheter vs. surgical mitral valve interventions in patients with prior coronary artery bypass grafting

Mahmoud Ismayl1, Hasaan Ahmed2, Andrew M Goldsweig3

  • 1Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

European Heart Journal. Quality of Care & Clinical Outcomes
|July 19, 2024
PubMed

Insights

Transcatheter mitral valve interventions are increasingly used in patients with prior coronary artery bypass grafting, showing similar mortality and readmission rates compared to surgical methods.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Many patients needing mitral valve (MV) intervention have a history of coronary artery bypass grafting (CABG).
  • Reoperative cardiac surgery carries elevated risks.

Purpose of the Study:

  • To compare the utilization and outcomes of transcatheter versus surgical MV interventions in patients with prior CABG.
  • To assess the safety and efficacy of minimally invasive approaches in this high-risk population.

Main Methods:

  • Analysis of the Nationwide Readmission Database (2016-2021).
  • Inclusion of adult patients with prior CABG undergoing transcatheter or surgical MV intervention.
  • Comparison of in-hospital outcomes and readmissions using multivariable regression, propensity-matching, and Cox proportional hazards models.

Main Results:

  • Transcatheter MV interventions increased significantly among patients with prior CABG from 2016-2021.
  • Similar in-hospital mortality and 180-day heart failure readmissions were observed for transcatheter versus surgical MV interventions.
  • Transcatheter approaches were associated with lower rates of stroke, acute kidney injury, permanent pacemaker placement, shorter length of stay, and fewer non-home discharges, but higher vascular complications with replacement.

Conclusions:

  • Transcatheter MV interventions are becoming the preferred choice for patients with prior CABG.
  • These procedures demonstrate comparable safety and effectiveness to surgical interventions regarding mortality and heart failure readmissions.
Abstract

Keywords:
In-hospital mortalityMitral valve diseaseMitral valve repairMitral valve replacementOutcomesReadmissions

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