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

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[Released on 10/11/2021]

Authors: Ayman Elbadawi MD , Dhruv Mahta MD , Islam Y. Elgendy MD , Alexander T. Dang MD , Mona Mahmoud MD , Mina Iskandar MD , Ryan Kaple MD , Karim Al‐Azizi MD , Molly Szerlip MD , Waleed Kayani MD , Colin M. Barker MD , Hani Jneid MD

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, Ptrend < 0.001), with a notable increase in the proportion of women (Ptrend = 0.04) and the prevalence of diabetes (Ptrend = 0.03). There was an increase in the number of centers performing TS‐TMVR (21 in 2015 vs. 164 in 2018, Ptrend < 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, Ptrend = 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 increase in the number of TS‐TMVR procedures over time, which is now performed at a greater number of centers. There was no change in the rate of in‐hospital mortality, complications or 30‐day readmissions; but a significant reduction in the length of hospital stay over time was noted. As the number of TS‐TMVR continue to expand, these data provide a perspective on the early experience with this procedure.

Keywords: mitral regurgitation; mitral valve disease; transcatheter mitral valve replacement; trans‐septal access.

Wiley

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

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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, Ptrend < 0.001), with a notable increase in the proportion of women (Ptrend = 0.04) and the prevalence of diabetes (Ptrend = 0.03). There was an increase in the number of centers performing TS‐TMVR (21 in 2015 vs. 164 in 2018, Ptrend < 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, Ptrend = 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 increase in the number of TS‐TMVR procedures over time, which is now performed at a greater number of centers. There was no change in the rate of in‐hospital mortality, complications or 30‐day readmissions; but a significant reduction in the length of hospital stay over time was noted. As the number of TS‐TMVR continue to expand, these data provide a perspective on the early experience with this procedure.

Keywords: mitral regurgitation; mitral valve disease; transcatheter mitral valve replacement; trans‐septal access.

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