Transcatheter mitral valve repair with the Mitraclip device has become a therapeutic option for patients with moderate to severe mitral regurgitation (MR) and high surgical risk. There are limited data evaluating Mitraclip outcomes in younger patients, although limited studies suggest decreased mortality in younger patients. As severe MR has increasing become recognized in younger patients, there is a need to investigate outcomes with Mitraclip in these subjects. Based on limited available data, our hypothesis was adverse clinical outcomes, including readmission, would be significantly lower among younger subjects following Mitraclip. The National Readmission Database (NRD) for 2018 and 2019 was queried to identify patients undergoing transcatheter mitral valve repair using ICD-10 procedure code ‘02UG3JZ’. Patients were stratified into 3 age groups: < 65, 65-80, and > 80 years of age (yoa) for comparison of readmission rates and risk factors. A total of 9742 who underwent Mitraclip were included in the study. The mean age of included subjects was 77 yoa, and 56 % were male. Approximately 16% had diabetes, 70% had hypertension, and 27% had chronic lung disease. Approximately 87% of subjects had Medicare coverage, while 3% had Medicaid, and 8% had private insurance. Approximately 90% of patients were cared for in 90% teaching hospitals. The overall rate of readmission following Mitraclip was 14%. While there was no difference in readmission by sex for subjects < 65 or > 80, there was a significant increase in readmission for women in comparison to men who were 65-80 yoa (15.8 vs. 12.4%, P < 0.01). There was a significant decrease in rate of readmission for subjects > 80% in 2019 in comparison to 2018 (13.1 vs. 15.5%, P = 0.03). There was significant increase in readmission to teaching hospitals in comparison to non-teaching hospitals for individuals < 65 (15.0 vs. 9.8%, P < 0.01). Rate of readmission was significantly higher for individuals > 80 and 65-80 yoa with chronic lung disease (17.7 vs 13.1%, P < 0.01). For all studied age groups, uncontrolled hypertension was associated with increased rate of readmission (P <0.02). Our studies suggest overall similar outcomes for younger patients undergoing Mitraclip in comparison to other populations.
We describe a patient in whom this anomaly was diagnosed during cardiac
catheterization for evaluation of progressive shortness of breath and
mild to moderate mitral regurgitation founded on a transthoracic
echocardiogram.A 58-year-old hypertensive female was evaluated for
progressive shortness of breath. Her physical examination showed a
regular heart rate and rhythm, with normal heart sounds with a
holosystolic systolic murmur on the 4th intercostal midclavicular line
on auscultation. Electrocardiography showed normal sinus rhythm and
criteria and possible left ventricular hypertrophy. Stress
Echocardiogram showed with no evidence of ischemia preserved left
ventricular function with an ejection fraction of 55-60%, with mild to
moderate mitral regurgitation. Patient underwent a coronary
catheterization for persistent shortness of breath which indicated no
evidence of obstructive coronary disease, normal left ventricular
function with mild to moderate mitral insufficiency. Angiography of the
right coronary artery showed a very large and tortuous artery that
collateralizes into the left main system and supplies the entire left
coronary artery system. The left main coronary origin was from the
pulmonary artery. CTA confirmed the same findings. The recommendations
between cardiology and cardiothoracic surgery were to maximize medical
therapy and follow up due to lack of myocardial ischemia or severe
valvular disease. Currently there are no guidelines or gold standard
management for patients with adult form of ALCAPA that present without
ischemic burden or for patients with the disease that present
asymptomatic with significant coronary collateralization.
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