Impact of age and comorbidities on the effect of transcatheter versus surgical mitral valve repair on inpatient outcomes

Abstract

Background: Transcatheter mitral valve repair (TMVR) has shown to be a safe and effective treatment option for symptomatic severe mitral regurgitation (MR) in patients who are at prohibitive surgical risk. Whether age and comorbidities impact the inpatient safety outcomes of TMVR versus surgical mitral valve repair (SMVR) is unknown.Methods: Using the national inpatient sample, patients undergoing either elective TMVR or SMVR between 2012 and 2015 were analyzed. Logistic, generalized logistic, and linear regression were used to compare inpatient complications, discharge disposition, and length of stay (LOS). Heterogeneity in the effect of TMVR versus SMVR across Charlson comorbidity index (CCI, categorized as <2 and ≥2) and age (categorized as <75 years old and ≥75 years old) were assessed for effect modification.Results: Overall, 8,716 hospitalizations were included, 7,950 (91%) SMVR and 766 (9%) TMVR. Compared with SMVR, patients undergoing TMVR were older (median age 79 vs. 62 years) and more likely to be female (45% vs. 40%) with a higher CCI score (median CCI 2 vs. 1). Despite being older with a higher comorbidity burden, patients undergoing TMVR had a lower incidence of permanent pacemaker implantation (OR 0.23, 95% CI: 0.11, 0.50), cerebrovascular accidents (OR 0.37, 95% CI: 0.15, 0.92), and major bleeding (OR 0.39, 95% CI: 0.32, 0.47). TMVR patients were also discharged 3 days earlier (CIE −3.26; 95% CI: −3.72, −2.80) and were less likely to be discharged to a skilled nursing facility (OR 0.72, 95% CI 0.55, 0.93). Additionally, the relative reduction in complications after TMVR versus SMVR was significantly higher in older (age ≥75 years) and more comorbid (CCI ≥2) patients (p for interaction <.05 for both). Conclusion:Patients treated with TMVR, as compared with SMVR, were older and had more comorbidities, but had a lower incidence of inpatient complications, shorter Abbreviations: CCI, Charlson comorbidity index; LOS, length of stay; MR, mitral regurgitation; NIS, national inpatient sample; PPM, permanent pacemaker implantation; SMVR, surgical mitral valve repair; TMVR, transcatheter mitral valve repair.Hanumantha R. Jogu and Sameer Arora have contributed equally to this article.

Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation?

“…This ensured maximal representation of the only RCT of Mitraclip versus surgical repair to date. One study 21 utilized patients from a national inpatient sample. While this study represented a high throughput of patient data, there was the potential of patient overlap with other studies in the analysis, as a result this study was excluded to try to maintain validity.…”

Transcatheter Mitral Edge-to-Edge Repair in Patients with Primary or Secondary Mitral Regurgitation

“…Four of the included retrospective cohort studies were published in 2020 6,14,17,18 while 1 was published in 2018 15 and another in 2016. 16 Three of the studies 14,17,18 used data from the National Inpatient Sample database of the US, and another study 6 was based on data from the Nationwide Readmission Database of the US. Each of the remaining 2 studies 15,16 was conducted using patient data retrieved from records of 2 separate hospitals (one per each study).…”

“…Each of the 4 included SRs had lead authors from the UK, 3 the US, 4 China, 8 or Portugal. 13 Four of the 6 retrospective cohort studies were conducted in the US 6,14,17,18 while 1 was conducted in Germany 15 and another 1 in Italy. 16…”

“…The number of patients in the retrospective cohort studies varied from hundreds for the single-centre studies 15,16 (148 to 378) to thousands for the national database-dependent studies 6,14,17,18 (2,910 to 19,580). One study used data for patients with severe MR 14 and another was conducted in patients with severe or moderately severe secondary MR. 16 The other studies did not provide information regarding the MR severity of the patients.…”

“…The number of patients in the retrospective cohort studies varied from hundreds for the single-centre studies 15,16 (148 to 378) to thousands for the national database-dependent studies 6,14,17,18 (2,910 to 19,580). One study used data for patients with severe MR 14 and another was conducted in patients with severe or moderately severe secondary MR. 16 The other studies did not provide information regarding the MR severity of the patients. The authors indicated that overall, patients in the TMVR groups were older and had more comorbidities or surgical risk than those in the SMVR group, except in 1 study 17 that used a propensity score matching approach to match patients from the 2 groups whose data were used in analyses.…”