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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
National Trends in Mitral Valve Surgery Outcomes in Centers With and Without Mitral Transcatheter Edge-to-Edge Repair
Sophia R Pyeatte1, Maxwell C Braasch1, Cameran Jones1
1Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
Background:
Valve guidelines recommend mitral valve transcatheter edge-to-edge repair (M-TEER) be offered at comprehensive valve centers along with complex mitral valve surgery (MVS). We evaluated mitral valve surgery (MVS) outcomes based on center availability of M-TEER on a national scale.
Methods:
The National Readmissions Database was used to review adult patients who underwent MVS at centers with and without M-TEER from 2016 to 2020. Patients with a history of endocarditis or prosthetic valve dysfunction were excluded. The primary outcome was 30-day mortality. Multivariable logistic regression analysis was conducted to determine the effect of M-TEER availability on postoperative mortality.
Results:
Of the 50,179 patients who underwent MVS from 2016 to 2020, 15,485 underwent MVS at a non-M-TEER hospital. During this period, the number of centers with M-TEER significantly increased from 2539 in 2016 to 6326 in 2020 (P < .05). The annual volume of M-TEER procedures performed significantly increased, whereas there was no significant change in the annual volume of MVS. Patients at non-M-TEER hospitals tended to be older, male, with higher rates of comorbidities and prior cardiac interventions (all P < .05). MVS 30-day mortality was significantly higher at non-M-TEER centers than at M-TEER centers (6.7% vs 5.0%, P < .001). Multivariable analysis showed non-M-TEER hospital status was independently associated with higher 30-day mortality (odds ratio 1.21; 95% CI 1.09-1.33) after MVS.
Conclusions:
Centers with M-TEER have significantly lower 30-day mortality after MVS than centers without M-TEER. This study supports the concept of a comprehensive valve center in the treatment of mitral valve disease.
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