Trends in utilization, outcomes, and readmissions after transcatheter mitral valve replacement

Abstract

Background: There is a paucity of real-world data regarding the temporal trends and outcomes of trans-septal transcatheter mitral valve replacement (TS-TMVR) in the United States (US). Methods:We queried the Nationwide Readmissions Database (October 2015 to December 2018) for patients undergoing TS-TMVR procedures. We reported the temporal trends in the utilization, in-hospital outcomes and 30-day readmissions after TS-TMVR. The main study outcome was in-hospital mortality.Results: There was an increase in the number of TS-TMVR procedures over time (48 in 2015 vs. 978 in 2018, P trend < 0.001), with a notable increase in the proportion of women (P trend = 0.04) and the prevalence of diabetes (P trend = 0.03). There was an increase in the number of centers performing TS-TMVR (21 in 2015 vs. 164 in 2018, P trend < 0.001). The overall in-hospital mortality was 7.2% with no change over time (6.3% in 2015 vs. to 5.2% in 2018, P trend = 0.67). There was no change in the frequency of in-hospital complications after TS-TMVR; however, the median length of stay has decreased over time. The overall 30-day readmission rate was 17.8%, with no change during the study years. The most frequent cause for 30-day readmission after TS-TMVR was acute heart failure followed by bleeding and infection-related complications. Prior coagulopathy and small-sized hospitals were independently associated with higher in-hospital mortality and 30-day readmissions. Conclusion:This nationwide observational analysis of real-world data showed an

Mortality and resource utilization in surgical versus transcatheter repeat mitral valve replacement: A national analysis

“…The observed increase in transcatheter utilization for redo mitral valve replacement is consistent with prior reports [ 13 , 14 , 31 , 32 ]. However, several concerns regarding the anatomical and technical challenges of transcatheter valve placement remain [ 10 , 11 ].…”

“…As the number of annual TMVR cases in redo operations continues to rise [ 31 ], large-scale examination of surgical and transcatheter approaches is necessary. We used a contemporary national representative cohort of repeat mitral valve replacement patients and made several important observations.…”

Impact of sex on in‐hospital mortality and 90‐day readmissions in patients undergoing transcatheter mitral valve replacement (TMVR): Analysis from the nationwide readmission database

“…Despite increasing in volumes of TMVR procedures performed yearly, we did not observe improvements in mortality or readmission rates across the years for either sex. This finding affirms Elbadawi et al, 38 who also found persistent mortality and readmission rates despite the increased number of TMVR procedures. This is in contrast to TAVR, in which 90‐day readmission rates decreased significantly between 2012 and 2017 11 .…”

“…These causes are similar to the causes of TMVR readmission reported by Elbadawi et al 38 and the causes following other valvular procedures including TAVR and TEER. 11,12 Pajjuru et al 11 reported the most common causes of readmission following TAVR to be heart failure followed by sepsis.…”

“…When evaluating causes of 90‐day readmission following TMVR, heart failure was the most common cause in both sexes followed by bleeding. These causes are similar to the causes of TMVR readmission reported by Elbadawi et al 38 and the causes following other valvular procedures including TAVR and TEER 11,12 . Pajjuru et al 11 reported the most common causes of readmission following TAVR to be heart failure followed by sepsis.…”