Sex Differences in In-Hospital Outcomes of Transcatheter Mitral Valve Repair (from a National Database).
- 作者列表："Elbadawi A","Elzeneini M","Thakker R","Mahmoud K","Elgendy IY","Megaly M","Hamed M","Omer MA","Chowdhury M","Ogunbayo G","Kamal D","Rangassety U","Jneid H","Gilani S","Khalife W
:There is paucity of data on sex differences in outcomes of transcatheter mitral valve repair (TMVR). We queried the National Inpatient Sample database (2012-2016) to identify hospitalizations for TMVR. We conducted a propensity matching analysis to compare hospitalizations for TMVR in men versus women. Our analysis yielded 10,014 hospitalizations for TMVR. TMVR was increasingly performed in both sexes at similar rate. Compared with men, women undergoing TMVR had fewer major comorbidities. After matching, there was no difference in in-hospital mortality between men and women (3.0% vs 2.4%, p = 0.33). Also, there was no difference between men and women in cardiac arrest (2.1% vs 1.3%, p = 0.17), cardiogenic shock (3.9% vs 3.5%, p = 0.66), mechanical support devices (2.4% vs 2.9%, p = 0.45), acute kidney injury (17.8% vs 14.7%, p = 0.08), hemodialysis (1.7% vs 1.6%, p = 0.81), respiratory complications (1.7% vs 1.4%, p = 0.65), acute stroke (1.4% vs 1.3%, p = 0.82), discharges to nursing facilities (12.3% vs 15.2%, p = 0.09), tamponade (0.5% vs 0.4%, p = 0.69), acute myocardial infarction (2.1% vs 2.4%, p = 0.71), and mean length of stay (6.03 ± 8.153 vs 6.08 ± 8.858 days, p = 0.82). TMVR in men was associated with higher incidence of ventricular arrhythmias (7.2% vs 4.1%, p = 0.01) and lower incidence of pacemaker implantations (0.4% vs 1.7%, p = 0.01). In conclusion, this observational study showed that TMVR is increasingly performed in both sexes at similar rate. Despite that women had less comorbidities, there was no difference in in-hospital mortality and major complications for TMVR among women compared with men. Future studies comparing the differences between both sexes in long-term outcomes are encouraged.
: 关于经导管二尖瓣修复术 (TMVR) 结局的性别差异的数据很少。我们查询了国家住院患者样本数据库 (2012-2016)，以确定TMVR的住院治疗。我们进行了一项倾向匹配分析，比较男性与女性TMVR住院治疗情况。我们的分析产生了10,014例TMVR住院治疗。TMVR在男女两性中的发生率相似。与男性相比，接受TMVR的女性主要合并症较少。匹配后，男女住院死亡率无差异 (3.0% vs 2.4%，p = 0.33)。此外，在心脏骤停 (2.1% vs 1.3%，p = 0.17) 、心源性休克 (3.9% vs 3.5%，p = 0.66) 、机械支持装置 (2.4% vs 2.9%，p = 0.45) 、急性肾损伤 (17.8% vs 14.7%，P = 0.08) 、血液透析 (1.7% vs 1.6%，p = 0.81) 、呼吸系统并发症(1.7% vs 1.4%，p = 0.65)，急性脑卒中患者，差异有统计学意义 (1.4% vs 1.3%，p = 0.82)，放电护理设施，差异有统计学意义 (12.3% vs 15.2%，p = 0.09)，填塞组 (0.5% vs 0.4%，p = 0.69)，急性心肌梗死 (ami)，差异有统计学意义 (2.1% vs 2.4%，P = 0.71) 和平均住院时间 (6.03 ± 8.153 vs 6.08 ± 8.858天，p = 0.82).男性TMVR与较高的室性心律失常发生率 (7.2% vs 4.1%，p = 0.01) 和较低的起搏器植入发生率 (0.4% vs 1.7%，p = 0.01) 相关。总之，这项观察性研究表明，TMVR在两性中的发生率越来越接近。尽管女性的合并症较少，但与男性相比，女性TMVR的住院死亡率和主要并发症没有差异。未来的研究，比较两性之间的长期结果的差异，鼓励。
METHODS::Relapsing polychondritis is a rare multi-system disease characterized by inflammation in cartilaginous structures and other connective tissues. Cardiovascular complications occur in 10-51% of the patients. We report a case of concomitant aortic valve replacement, mitral valve replacement, and coronary artery bypass grafting in a patient with relapsing polychondritis. A 71-year-old female with relapsing polychondritis on prednisolone (5 mg/day) for 15 years presented at our hospital for further evaluation of valvular disease. Severe aortic stenosis and severe mitral regurgitation were diagnosed. We performed aortic and mitral valve replacement. During surgery, we found connective tissue surrounding the intima of the sinus of Valsalva and stenosis of the right coronary artery ostium, which was not noted on preoperative coronary angiography. We removed the tissue and performed bypass grafting to the right coronary artery. Postoperative recovery was uneventful, and she was discharged 27 days after surgery.
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.
METHODS:BACKGROUND:Among elderly with severe aortic stenosis (AS), Comprehensive Geriatric Assessment (CGA) originally contributed to address to transcatheter aortic valve implantation (TAVI) patients not suitable to surgical aortic valve replacement(SAVR). Nevertheless, TAVI has recently been proposed also in lower surgical risk patients. AIMS:To evaluate predictors of TAVI procedure and clinical outcomes among these patients. METHODS:For each patient ≥ 65 years with severe AS referring to our Cardiac Surgery Division, CGA was performed, including functional and cognitive status, comorbidity burden, frailty, nutritional status, gait speed, hand-grip strength and number of medications. Surgical risk was evaluated according to the Society of Thoracic Surgeons (STS) score (low-risk < 4%). Post-procedural outcomes (30-day survival and post-procedural complications) were obtained by medical records and a one-year follow-up assessed survival, and functional and cognitive performance. RESULTS:Among 154 subjects (mean age 82.9 years), 52 were at low-risk according to STS score. 32 patients were addressed to TAVI, 20 to SAVR. Variables significantly associated with TAVI-approach were lower gait speed (p 0.030) and higher number of medications (p 0.015). Short and long-term outcomes did not differ between groups. DISCUSSION:Among CGA variables, gait speed and number of medications were associated with the decision to perform TAVI instead of SAVR, even in patients at low surgical risk. 30-day and one-year survival and one-year functional and cognitive decline were similar between groups, despite a relevant prevalence of frailty in the TAVI group. CONCLUSIONS:We suggest that gait speed and number of medications should be considered in selecting appropriate candidates to TAVI among low surgical risk patients.