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Contemporary Trends and Outcomes of Percutaneous and Surgical Mitral Valve Replacement or Repair in Patients With Cancer.

癌症患者经皮和外科二尖瓣置换或修复的当代趋势和结果。

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.01.047
  • 作者列表:"Guha A","Dey AK","Omer S","Abraham WT","Attizzani G","Jneid H","Addison D
  • 发表时间:2020-05-01
Abstract

:In the era of emerging options for mitral valvular intervention, we sought to characterize the relative utilization, outcomes, and posthospital dispositions of patients referred for transcatheter mitral valve repair (TMVRepair) and surgical mitral valve procedures (SMVP), by cancer-status. Leveraging the National Inpatient Sample, a representative national dataset, ICD-9 codes for all adults >18 years with co-morbid mitral regurgitation, and cancer without metastatic disease admitted from 2003 to 2015 were queried. TMVRepair was performed in 700 hospitalizations from 2012 to 2015, whereas SMVP was utilized during 12,863 hospitalizations from 2003 to 2015. During follow-up, we observed a proportional increase in TMVRepair utilization among cancer patients (vs noncancer), particularly in 2015 (14.2% vs 8.2%, p <0.0001). There was no difference in in-hospital mortality (1.4% vs 1.8%, p = 0.71), ischemic stroke (0.7% vs 0.6%, p = 0.97), major bleeding (8.6% vs 10.9%, p = 0.36), and home discharge (62.1% vs 65.7%, p = 0.45) by cancer-status among patients who underwent TMVRepair; but, cost of care was increased ($52,325 vs $48,832, p <0.0001). Similarly, there was no difference in in-hospital mortality (3.1% vs 3.4%, p = 0.36), ischemic stroke (2.6% vs 3.1%, p = 0.16) as well as the cost-of-care ($58,106 vs $58,844, p = 0.49) among those who underwent SMVP across the same period; but, cancer was associated with increased major bleeding (34.9% vs 30.5%, p <0.0001), and lower likelihood of home discharge (32.8% vs 38.6%, p <0.0001). In conclusion, TMVRepair and SMVP were associated with comparable in-hospital mortality and outcomes in cancer versus noncancer patients. However, cancer patients treated with SMVP experienced more frequent bleeding related complications compared with noncancer patients.

摘要

: 在二尖瓣介入治疗的新兴选择时代,我们试图通过癌症状态来描述接受经导管二尖瓣修复 (TMVRepair) 和外科二尖瓣手术 (SMVP) 的患者的相对利用率、结局和术后处置。利用国家住院患者样本 (一个具有代表性的国家数据集),查询了2003年至2015年期间收治的所有> 18岁合并二尖瓣反流的成人和无转移性疾病的癌症的ICD-9编码.从2012年至2015年,在700例住院患者中进行了TMVRepair,而从2003年至2015年,在12,863例住院患者中使用了SMVP。在随访期间,我们观察到癌症患者 (与非癌症) 中TMVRepair利用率成比例增加,特别是在2015年 (14.2% vs 8.2%,p <0.0001)。无差异住院死亡率 (1.4% vs 1.8%,p  =   0.71),缺血性中风 (0.7% vs 0.6%,p  =   0.97) 、严重出血 (8.6% vs 10.9%,p  =   0.36) 和家庭放电 (62.1% vs 65.7%,p  =   0.45) 通过接受TMVRepair的患者中的癌症状态; 但是,护理成本增加了($52,325 vs $48,832,p <0.0001)。同样,住院死亡率 (3.1% vs 3.4%,p   = 0.36) 、缺血性卒中 (2.6% vs 3.1%,p   =   0.16) 以及医疗费用 ($58,106 vs $58,844,p   =   0.49) 也没有差异。在同期接受SMVP的患者中; 但是,癌症与大出血增加有关(34.9% vs 30.5%,p <0.0001),家庭出院的可能性较低 (32.8% vs 38.6%,p <0.0001)。总之,TMVRepair和SMVP与癌症与非癌症患者的住院死亡率和结局相当。然而,与非癌症患者相比,用SMVP治疗的癌症患者经历更频繁的出血相关并发症。

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影响因子:1.52
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作者列表:["Tang PC","Haft JW","Romano MA","Bitar A","Hasan R","Palardy M","Wu X","Aaronson KD","Pagani FD"]

METHODS:BACKGROUND:The effect of significant mitral regurgitation (MR) on outcomes after continuous flow left ventricular assist device (cfLVAD) implantation remains unclear. METHODS:We performed a retrospective review of prospectively collected data from 159 patients with preoperative severe MR who underwent cfLVAD implantation (2003-2017). Two-step cluster analysis using the log-likelihood distance for post-cfLVAD implantation parameters, which included right ventricular (RV) dysfunction, MR severity, and tricuspid regurgitation (TR) severity. Post-cfLVAD implantation echocardiographic parameters were obtained within the first month. RESULTS:Cluster analysis resulted in 3 groups. Group 1 (n = 67) had mild or less MR with moderate-severe RV dysfunction (RVD). Group 2 (n = 43) had moderate-severe MR with moderate-severe RVD. Group 3 (n = 49) had moderate MR with mild RVD. Group 2 had the largest proportion with Interagency Registry for Mechanically Assisted Circulatory Support score of 1 (30.2%) and 2 (41.9%). They were more likely to undergo temporary mechanical circulatory support (18.6%) and tricuspid valve procedure (62.8%). Group 2 had the highest rate of stroke (30.2%; P = .02), hemolysis (39.5%; P = .01), device thrombosis (30%; P = .01), and worst survival (46.5%; P = .01). Survival at 5 years for groups 1, 2, and 3 were 56.0%, 17.6%, and 55.8%. Regression analysis of the entire population showed that greater MR severity after cfLVAD was associated with RV failure (P < .05; odds ratio, 1.6) and RV assist device use (P = .09; odds ratio, 1.6). After excluding tricuspid valve repairs, MR severity had a positive correlation with TR severity (R = 0.33; P < .01). CONCLUSIONS:After cfLVAD implantation, moderate-severe MR and RVD predicted RV failure. Patients with preoperative moderate-severe MR and TR coupled with moderate-severe RVD might benefit the most from mitral and tricuspid valve intervention.

影响因子:2.15
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DOI:10.1007/s40520-019-01228-0
作者列表:["Bo M","Bergamo D","Calvi E","Iacovino M","Falcone Y","Grisoglio E","Salizzoni S"]

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心脏瓣膜病方向

人的心脏有四个瓣膜,分别为二尖瓣、三尖瓣、主动脉瓣和肺动脉瓣。心脏瓣膜病就是指二尖瓣、三尖瓣、主动脉瓣和肺动脉瓣的瓣膜因风湿热、黏液变性、退行性改变、先天性畸形、缺血性坏死、感染或创伤等出现了病变,影响血流的正常流动,从而造成心脏功能异常,最终导致心力衰竭的单瓣膜或多瓣膜病变。随着人口老龄化加重,老年性瓣膜病以及冠心病、心肌梗死后引起的瓣膜病变也越来越常见。

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