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Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting

AIMS: Patients with severe ischemic mitral regurgitation (IMR) may receive concurrent coronary artery bypass graft (CABG) with surgical mitral valve repair (SMVr) or percutaneous coronary stent implantation (PCI) with transcatheter edge-to-edge mitral valve repair (TMVr). However, there is no consen...

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Autores principales: Wang, Xiqiang, Ma, Yanpeng, Liu, Jing, Wang, Ting, Zhu, Ling, Fan, Xiude, Cui, Qianwei, Liu, Chengfeng, Guan, Gongchang, Wang, Junkui, Pan, Shuo, Liu, Zhongwei, Zhang, Yong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9810628/
https://www.ncbi.nlm.nih.gov/pubmed/36620639
http://dx.doi.org/10.3389/fcvm.2022.953875
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author Wang, Xiqiang
Ma, Yanpeng
Liu, Jing
Wang, Ting
Zhu, Ling
Fan, Xiude
Cui, Qianwei
Liu, Chengfeng
Guan, Gongchang
Wang, Junkui
Pan, Shuo
Liu, Zhongwei
Zhang, Yong
author_facet Wang, Xiqiang
Ma, Yanpeng
Liu, Jing
Wang, Ting
Zhu, Ling
Fan, Xiude
Cui, Qianwei
Liu, Chengfeng
Guan, Gongchang
Wang, Junkui
Pan, Shuo
Liu, Zhongwei
Zhang, Yong
author_sort Wang, Xiqiang
collection PubMed
description AIMS: Patients with severe ischemic mitral regurgitation (IMR) may receive concurrent coronary artery bypass graft (CABG) with surgical mitral valve repair (SMVr) or percutaneous coronary stent implantation (PCI) with transcatheter edge-to-edge mitral valve repair (TMVr). However, there is no consensus on the management of severe IMR in this setting. We aimed to compare the outcomes of combined SMVr with CABG to concurrent TMVr with PCI among patients with IMR in the National Inpatient Sample (NIS) database. METHODS AND RESULTS: The National Inpatient Sample was queried for all patients diagnosed with IMR who underwent SMVr with CABG or TMVr with PCI during the years 2016–2018. Study outcomes included all-cause in-hospital mortality, periprocedural complications, and resources used. A total of 1,360 potentially eligible patients were included in the study. After 1:5 propensity score matching, 133 patients were classified in the SMVr + CABG group and 29 patients in the TMVr + PCI group. Adjusted mortality was higher in the TMVr + PCI group compared with the SMVr + CABG group (13.8% vs. 4.5%, P = 0.034). Perioperative complications were higher among patients who underwent SMVr + CABG including blood transfusions (29.3% vs. 6.9%, P = 0.01) and post-procedural cardiogenic shock (11.3% vs. 0%, P = 0.044). The cost of care was higher (USD$783548.80 vs. USD$331846.523, P = 0.001) and the length of stay was longer (17.9 vs. 15.44 days, P < 0.001) in the TMVr + PCI group. On multivariable analysis, age (OR, 1.039 [95% CI, 1.006–1.072]; P = 0.032), renal failure (OR, 3.465 [95% CI, 1.867–6.433]; P < 0.001), and liver disease (OR, 5.012 [95% CI, 2.578–9.686]; P < 0.001) were associated with in-hospital mortality. CONCLUSION: TMVr + PCI was associated with higher resource use and in-hospital mortality but with improved perioperative complications compared with SMVr + CABG.
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spelling pubmed-98106282023-01-05 Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting Wang, Xiqiang Ma, Yanpeng Liu, Jing Wang, Ting Zhu, Ling Fan, Xiude Cui, Qianwei Liu, Chengfeng Guan, Gongchang Wang, Junkui Pan, Shuo Liu, Zhongwei Zhang, Yong Front Cardiovasc Med Cardiovascular Medicine AIMS: Patients with severe ischemic mitral regurgitation (IMR) may receive concurrent coronary artery bypass graft (CABG) with surgical mitral valve repair (SMVr) or percutaneous coronary stent implantation (PCI) with transcatheter edge-to-edge mitral valve repair (TMVr). However, there is no consensus on the management of severe IMR in this setting. We aimed to compare the outcomes of combined SMVr with CABG to concurrent TMVr with PCI among patients with IMR in the National Inpatient Sample (NIS) database. METHODS AND RESULTS: The National Inpatient Sample was queried for all patients diagnosed with IMR who underwent SMVr with CABG or TMVr with PCI during the years 2016–2018. Study outcomes included all-cause in-hospital mortality, periprocedural complications, and resources used. A total of 1,360 potentially eligible patients were included in the study. After 1:5 propensity score matching, 133 patients were classified in the SMVr + CABG group and 29 patients in the TMVr + PCI group. Adjusted mortality was higher in the TMVr + PCI group compared with the SMVr + CABG group (13.8% vs. 4.5%, P = 0.034). Perioperative complications were higher among patients who underwent SMVr + CABG including blood transfusions (29.3% vs. 6.9%, P = 0.01) and post-procedural cardiogenic shock (11.3% vs. 0%, P = 0.044). The cost of care was higher (USD$783548.80 vs. USD$331846.523, P = 0.001) and the length of stay was longer (17.9 vs. 15.44 days, P < 0.001) in the TMVr + PCI group. On multivariable analysis, age (OR, 1.039 [95% CI, 1.006–1.072]; P = 0.032), renal failure (OR, 3.465 [95% CI, 1.867–6.433]; P < 0.001), and liver disease (OR, 5.012 [95% CI, 2.578–9.686]; P < 0.001) were associated with in-hospital mortality. CONCLUSION: TMVr + PCI was associated with higher resource use and in-hospital mortality but with improved perioperative complications compared with SMVr + CABG. Frontiers Media S.A. 2022-12-21 /pmc/articles/PMC9810628/ /pubmed/36620639 http://dx.doi.org/10.3389/fcvm.2022.953875 Text en Copyright © 2022 Wang, Ma, Liu, Wang, Zhu, Fan, Cui, Liu, Guan, Wang, Pan, Liu and Zhang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Wang, Xiqiang
Ma, Yanpeng
Liu, Jing
Wang, Ting
Zhu, Ling
Fan, Xiude
Cui, Qianwei
Liu, Chengfeng
Guan, Gongchang
Wang, Junkui
Pan, Shuo
Liu, Zhongwei
Zhang, Yong
Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting
title Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting
title_full Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting
title_fullStr Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting
title_full_unstemmed Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting
title_short Outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting
title_sort outcomes of transcatheter edge-to-edge mitral valve repair with percutaneous coronary intervention vs. surgical mitral valve repair with coronary artery bypass grafting
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9810628/
https://www.ncbi.nlm.nih.gov/pubmed/36620639
http://dx.doi.org/10.3389/fcvm.2022.953875
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