Incidence, Timing, Causes and Predictors of Early and Late Re-Hospitalization in Patients Who Underwent Percutaneous Mitral Valve Repair With the MitraClip System

Grasso, Carmelo; Rubbio, Antonio Popolo; Capodanno, Davide; Buccheri, Sergio; Salvo, M.; Cannata, Stefano; Scandura, Salvatore; Mangiafico, Sarah; Farruggio, Silvia; Salerno, Tatiana; Santis, Jessica De; Sanalitro, S; Caggegi, Anna; Castania, Giuseppe; Barbanti, Marco; Capranzano, Piera; Tamburino, Corrado

doi:10.1016/j.amjcard.2018.01.047

Cited by 19 publications

(17 citation statements)

References 28 publications

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“…15 A study that reviewed late admissions after TMVR revealed a propensity for GI bleed in this population (7.5%). 16 Our study is concurrent with other studies that TMVR patients are at elevated bleeding risk, but our study indicates higher risk than quoted in other studies because we specifically assessed the bleeding risk in the patients with AF who were frequently utilizing OAC.…”

Section: Discussionsupporting

confidence: 86%

An under‐recognized high‐risk atrial fibrillation population: Analyzing transcatheter mitral valve repair patients for left atrial appendage closure device application

Lane

Eleid

Holmes

2019

Cathet Cardio Intervent

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Objective Identify patients undergoing transcatheter mitral valve repair (TMVR) who could potentially benefit from alternative ischemic stroke prophylaxis utilizing a left atrial appendage closure (LAAC) device. Background Patients undergoing TMVR have a high incidence of atrial fibrillation (AF). The co‐morbidities which qualify them to undergo TMVR also increase their risk of stroke and bleeding, making stroke prophylaxis problematic. Methods We conducted a single‐center retrospective study, in which the bleeding and stroke risk of all patients undergoing TMVR for degenerative mitral valve disease were reviewed to determine candidacy for a LAAC device for stroke prevention as an alternative to chronic anticoagulation. Results AF was present in 122 (62%) of TMVR patients with an average CHA2DS2‐VASc score of 3.99. 23% of TMVR patients had a history of prior major bleeding event, predominately gastrointestinal bleed. Fifty‐three and 47% of TMVR patients were at high or intermediate risk of bleeding, respectively, according to their HAS‐BLED score. 50% of patients undergoing TMVR would qualify for LAAC device based on risk assessments. Conclusion Patients undergoing TMVR represent a high risk group of AF patients that may benefit from a LAAC device.

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Section: Discussionsupporting

confidence: 86%

An under‐recognized high‐risk atrial fibrillation population: Analyzing transcatheter mitral valve repair patients for left atrial appendage closure device application

Lane

Eleid

Holmes

2019

Cathet Cardio Intervent

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“…Still, increased 1‐year mortality was associated with LVEF <30% . Furthermore, in the GRASP‐IT registry, all‐cause rehospitalized patients had more often severely impaired left ventricular function . In particular, the deterioration of left ventricular function after MitraClip was predictive of all‐cause rehospitalization .…”

Section: Discussionmentioning

confidence: 97%

“…13 However, in this critically ill population with multiple cardiac and non-cardiac co-morbidities, rehospitalization occurs frequently after MitraClip implantation. Grasso et al 14…”

Section: Discussionmentioning

confidence: 99%

“…However, in this critically ill population with multiple cardiac and non‐cardiac co‐morbidities, rehospitalization occurs frequently after MitraClip implantation. Grasso et al . demonstrated that two thirds of hospital readmissions occur for cardiovascular reasons (including heart failure, coronary artery disease and myocardial infarction, hypertension, arrhythmias, stroke, and peripheral artery disease), while anaemia and gastrointestinal bleeding are the most frequent non‐cardiovascular causes of rehospitalization after MitraClip.…”

Section: Discussionmentioning

confidence: 99%

“…25 Furthermore, in the GRASP-IT registry, all-cause rehospitalized patients had more often severely impaired left ventricular function. 14 In particular, the deterioration of left ventricular function after MitraClip was predictive of all-cause rehospitalization. 14 In our analysis of 355 patients receiving MitraClip, moderate to severe impairment of LVEF (≤44%) was an independent predictor of 1-year rehospitalization with a hazard ratio of 2.…”

Section: P-valuementioning

confidence: 99%

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Predictors of rehospitalization after percutaneous edge‐to‐edge mitral valve repair by MitraClip implantation

Keßler

Seeger

Muche

et al. 2018

European J of Heart Fail

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After MitraClip implantation, annual rate of rehospitalization for decompensated heart failure was reduced by 65.8%. Baseline left ventricular ejection fraction, baseline troponin T and pre-procedural NYHA functional class are independent predictors for rehospitalization within the first year after MitraClip implantation. Patients readmitted for decompensated heart failure after MitraClip implantation had a 2.3-fold increased risk of all-cause mortality and a 3.3-fold increased risk of cardiovascular mortality compared to patients not requiring rehospitalization.

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Thirty‐day readmissions after transcatheter versus surgical mitral valve repair in high‐risk patients with mitral regurgitation: Analysis of the 2014–2015 Nationwide readmissions databases

Lima

Kolte

Rofeberg

et al. 2019

Cathet Cardio Intervent

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Objective Determine the rates, reasons, predictors, and costs of 30‐day readmissions following transcatheter mitral valve repair (TMVR) versus surgical mitral valve repair (SMVR) in the United States. Background Data on 30‐day readmissions after TMVR are limited. Methods High‐risk patients with mitral regurgitation (MR) undergoing TMVR or SMVR were identified from the 2014–2015 Nationwide Readmissions Databases. Multivariable stepwise regression models were used to identify independent predictors of 30‐day readmission. Risk of 30‐day readmission was compared between the two groups using univariate and propensity score adjusted regression models. Results Among 8,912 patients undergoing mitral valve repair during 2014–2015 (national estimate 17,809), we identified 7,510 (84.7%) that underwent SMVR and 1,402 (15.3%) that underwent TMVR. Thirty‐day readmission rates after SMVR and TMVR were 10.7% and 11.7%, respectively (unadjusted OR 1.11, 95% CI 0.89–1.39, p = .35). After propensity score adjustment, TMVR was associated with a lower risk of 30‐day readmissions compared with SMVR (adjusted OR 0.70, 95% CI 0.51–0.95, p = .02). Heart failure and arrhythmias were the leading cardiac reasons for readmission. Anemia and fluid and electrolyte disorder were independent predictors of 30‐day readmission after TMVR. Demographics, comorbidities, and length of stay were independent predictors of 30‐day readmission after SMVR. Conclusions One in 10 patients are readmitted within 30 days following TMVR or SMVR. Approximately half of the readmissions are for cardiac reasons. The predictors of 30‐day readmission are different among patients undergoing TMVR and SMVR, but can be easily screened for to identify patients at highest risk for readmission.

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Incidence, Timing, Causes and Predictors of Early and Late Re-Hospitalization in Patients Who Underwent Percutaneous Mitral Valve Repair With the MitraClip System

Cited by 19 publications

References 28 publications

An under‐recognized high‐risk atrial fibrillation population: Analyzing transcatheter mitral valve repair patients for left atrial appendage closure device application

An under‐recognized high‐risk atrial fibrillation population: Analyzing transcatheter mitral valve repair patients for left atrial appendage closure device application

Predictors of rehospitalization after percutaneous edge‐to‐edge mitral valve repair by MitraClip implantation

Thirty‐day readmissions after transcatheter versus surgical mitral valve repair in high‐risk patients with mitral regurgitation: Analysis of the 2014–2015 Nationwide readmissions databases

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