Does Pre-Existing PH Affect Outcomes in Transcatheter Mitral Valve Repair?
No major differences in hospital cost or length of stay were found between patients with pre-existing PH and those without PH.
In patients undergoing transcatheter mitral valve repair (TMVR) with the Mitraclip device, pre-existing pulmonary hypertension (PH) is not associated with adverse in-hospital outcomes, according to a study published in Catheterization and Cardiovascular Interventions.
Researchers conducted a retrospective study of patients who underwent TMVR with the Mitraclip between 2011 and 2015 (n=1037) using the National Inpatient Sample (NIS). The investigators defined the primary outcome as the effect of PH on inpatient mortality. Secondary outcomes included vascular complications necessitating surgical intervention, bleeding requiring transfusion, ischemic strokes, respiratory complications, postoperative deep venous thrombosis/pulmonary embolism, acute kidney injury requiring dialysis, sepsis, and cardiac complications. In addition, the estimated cost of hospitalization was calculated. Outcomes between patients undergoing TMVR with vs without pre-existing PH were also compared.
Overall, the prevalence of PH in the NIS cohort was 32.6%. In the analysis comparing those with and without PH, inpatient mortality rates were similar for both groups (3.2% vs 2.1%, respectively; odds ratio [OR], 1.57; P =.335). Additionally, no significant differences were found between the PH and non-PH groups with regard to rates of hemorrhage requiring transfusion (8.5% vs 7.2%, respectively; OR, 1.17; P =.587), cardiogenic shock (4.4% vs 4.5%, respectively; OR, 0.98; P =.951), acute respiratory failure (15.2% vs 13.1%, respectively; OR, 1.23; P =.460), postoperative sepsis (2.75% vs 3.9%, OR, 0.66; P =.340), or postoperative deep vein thrombosis or pulmonary embolism (2.7% vs 3.9%, respectively; OR, 1.98, P =.348). No differences were found between groups in terms of median hospital cost ($55,920 vs $52,590; OR, 1.06; P =.526) or length of stay (7.6 days vs 6.8 days, respectively; OR, 1.13; P =.316).
Study limitations included the reliance on NIS codes to identify patients, which may have led to the inclusion of patients for whom there were coding errors (eg, patients with idiopathic PH).
Although the researchers noted that TMVR with Mitraclip “represents a viable alternative to MV surgery which is associated with increased mortality in patients with PH,” further research, including prospective studies, will be necessary “to assess for long-term outcomes and to compare MV surgery vs TMVR.”
Ahmed A, Akintoye E, Adegbala O, et al. In-hospital outcomes of transcatheter mitral valve repair with Mitraclip in patients with pulmonary hypertension: insights from the National Inpatient Sample [published online December 2, 2018]. Catheter Cardiovasc Interv. doi:10.1002/ccd.27997