Comparison of In-Hospital Outcomes of Transcatheter Mitral Valve Repair in Patients With vs Without Pulmonary Hypertension (From the National Inpatient Sample)

Am J Cardiol. 2021 Aug 15:153:101-108. doi: 10.1016/j.amjcard.2021.05.022. Epub 2021 Jun 29.

Abstract

Pulmonary hypertension (PH) is common in patients with left heart disease and is present in varying degrees in patients with severe mitral valve disease. There is paucity of data regarding outcomes following transcatheter mitral valve repair (TMVr) in patients with PH. For this study, we analyzed NIS data from 2014 to 2018 using the ICD-9-CM and 10-CM codes. Baseline characteristics were compared using a Pearson chi-squared test for categorical variables and independent samples t-test for continuous variables. To account for selection bias, a 1:1 propensity match cohort was derived using logistic regression. Trend analysis was- done using linear regression. Of 21,505 encounters, 6780 encounters had PH. 6610 PH encounters were matched with 6610 encounters without PH. In-hospital mortality (3.3% versus 1.9%, p <0.01) was higher in PH population. Complications such as blood transfusion (3.6% versus 1.7%, p <0.01), GI bleed (1.4% versus 1%, p = 0.04), vascular complications (5.3% versus 3.3%, p <0.01), vasopressors use (2.9% versus 1.7%, p <0.01) and pacemaker placement (1.3% versus 0.8%, p = 0.01) remained significantly higher for encounters with PH. Multiple Logistic regression showed PH was associated with higher mortality (adjusted odds ratio [AOR], 1.68 [95% confidence interval [CI], 1.39-2.05], p <0.01). The mean length of stay (6.2 versus 5.3 days, p <0.01) and cost per hospitalization ($53,780 versus $50,801, p <0.01) remained significantly higher in the PH group when compared to group without PH. In conclusion, TMVr in PH as compared to without PH is associated with higher mortality, post-procedure complication rates, length of stay, and cost of stay.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Transfusion / statistics & numerical data
  • Cardiac Catheterization*
  • Comorbidity
  • Female
  • Gastrointestinal Hemorrhage / epidemiology
  • Health Care Costs / statistics & numerical data
  • Hospital Mortality*
  • Humans
  • Hypertension, Pulmonary / epidemiology*
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Mitral Valve Annuloplasty*
  • Mitral Valve Insufficiency / epidemiology
  • Mitral Valve Insufficiency / surgery*
  • Odds Ratio
  • Pacemaker, Artificial
  • Postoperative Complications / epidemiology*
  • Postoperative Hemorrhage / epidemiology
  • Vasoconstrictor Agents / therapeutic use

Substances

  • Vasoconstrictor Agents