Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample
Background Redo mitral valve surgery is required in up to one‐third of patients and is associated with significant mortality and morbidity. Valve‐in‐valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comp...
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doaj-825dbe47c34042fca431c25884ace92f2021-09-07T18:11:47ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-09-01101710.1161/JAHA.121.020948Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient SampleMuhammad Zia Khan0Salman Zahid1Muhammad U. Khan2Asim Kichloo3Shakeel Jamal4Abdul Mannan Khan Minhas5Waqas Ullah6Yasar Sattar7Sudarshan Balla8Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WVDepartment of Medicine Rochester General Hospital Rochester NYDivision of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WVSt. Mary’s of Saginaw Hospital Saginaw MISt. Mary’s of Saginaw Hospital Saginaw MIForrest General Hospital Hattiesburg MSAbington Jefferson Health PADivision of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WVDivision of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WVBackground Redo mitral valve surgery is required in up to one‐third of patients and is associated with significant mortality and morbidity. Valve‐in‐valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real‐world outcomes of the above procedures using the National Inpatient Sample database. Methods and Results We analyzed National Inpatient Sample data using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) from September 2015 to December 2018. A total of 495 and 2250 patients underwent redo ViV TMVR and SMVR, respectively. The patients who underwent ViV TMVR were older (77 versus 68 years, P<0.01). Adjusted mortality was higher in the redo SMVR group compared with the ViV TMVR group (7.6% versus <2.8%, P<0.01). Perioperative complications were higher among patients undergoing redo SMVR including blood transfusions (38% versus 7.6%, P<0.01) and acute kidney injury (36.7% versus 13.9%, P<0.01). Cost of care was higher (USD$57 172 versus USD$52 579, P<0.01), length of stay was longer (10 versus 3 days, P<0.01), and discharge to home was lower (20.3% versus 64.6%, P<0.01) in the SMVR group compared with the ViV TMVR group. Conclusions ViV TMVR is associated with lower mortality, periprocedural morbidity, and resource use compared with patients undergoing redo SMVR. ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction. Studies evaluating long‐term outcomes and durability of ViV TMVR are needed. A patient‐centered approach by the heart team, local institutional expertise, and careful preprocedure planning can help decision‐making about the choice of intervention for the individual patient.https://www.ahajournals.org/doi/10.1161/JAHA.121.020948redo mitral valve surgeryredo valve replacementtranscatheter mitral valve in valve |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Muhammad Zia Khan Salman Zahid Muhammad U. Khan Asim Kichloo Shakeel Jamal Abdul Mannan Khan Minhas Waqas Ullah Yasar Sattar Sudarshan Balla |
spellingShingle |
Muhammad Zia Khan Salman Zahid Muhammad U. Khan Asim Kichloo Shakeel Jamal Abdul Mannan Khan Minhas Waqas Ullah Yasar Sattar Sudarshan Balla Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease redo mitral valve surgery redo valve replacement transcatheter mitral valve in valve |
author_facet |
Muhammad Zia Khan Salman Zahid Muhammad U. Khan Asim Kichloo Shakeel Jamal Abdul Mannan Khan Minhas Waqas Ullah Yasar Sattar Sudarshan Balla |
author_sort |
Muhammad Zia Khan |
title |
Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample |
title_short |
Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample |
title_full |
Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample |
title_fullStr |
Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample |
title_full_unstemmed |
Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample |
title_sort |
redo surgical mitral valve replacement versus transcatheter mitral valve in valve from the national inpatient sample |
publisher |
Wiley |
series |
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
issn |
2047-9980 |
publishDate |
2021-09-01 |
description |
Background Redo mitral valve surgery is required in up to one‐third of patients and is associated with significant mortality and morbidity. Valve‐in‐valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real‐world outcomes of the above procedures using the National Inpatient Sample database. Methods and Results We analyzed National Inpatient Sample data using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) from September 2015 to December 2018. A total of 495 and 2250 patients underwent redo ViV TMVR and SMVR, respectively. The patients who underwent ViV TMVR were older (77 versus 68 years, P<0.01). Adjusted mortality was higher in the redo SMVR group compared with the ViV TMVR group (7.6% versus <2.8%, P<0.01). Perioperative complications were higher among patients undergoing redo SMVR including blood transfusions (38% versus 7.6%, P<0.01) and acute kidney injury (36.7% versus 13.9%, P<0.01). Cost of care was higher (USD$57 172 versus USD$52 579, P<0.01), length of stay was longer (10 versus 3 days, P<0.01), and discharge to home was lower (20.3% versus 64.6%, P<0.01) in the SMVR group compared with the ViV TMVR group. Conclusions ViV TMVR is associated with lower mortality, periprocedural morbidity, and resource use compared with patients undergoing redo SMVR. ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction. Studies evaluating long‐term outcomes and durability of ViV TMVR are needed. A patient‐centered approach by the heart team, local institutional expertise, and careful preprocedure planning can help decision‐making about the choice of intervention for the individual patient. |
topic |
redo mitral valve surgery redo valve replacement transcatheter mitral valve in valve |
url |
https://www.ahajournals.org/doi/10.1161/JAHA.121.020948 |
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