Thirty‐day readmissions after transcatheter versus surgical mitral valve repair in high‐risk patients with mitral regurgitation: Analysis of the 2014–2015 Nationwide readmissions databases

Background Transcatheter mitral valve repair (TMVR) is a treatment option for patients with 3+ or greater mitral regurgitation who cannot undergo mitral valve surgery. Outcomes in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD) are unclear. We sought to evaluate the TMVR in‐hospital outcomes, readmission rates and its impact on kidney function. Methods Data from 2016 National Readmission Database was used to obtain all patients who underwent TMVR. Patients were classified by their CKD status: no CKD, CKD, or ESRD. The primary outcomes were: in‐hospital mortality, 30‐ and 90‐day readmission rate, and change in CKD status on readmission. Multivariable logistic regression analysis was used to assess in‐hospital, readmission outcomes and kidney function stage. Results A total of 4,645 patients were assessed (mean age 78.5 ± 10.3 years). In‐hospital mortality was higher in patients with CKD (4.0%, odds ratio [OR]:2.01 [95% CI, confidence interval: 1.27–3.18]) and ESRD (6.6%, OR: 6.38 [95% CI: 1.49–27.36]) compared with non‐CKD (2.4%). 30‐day readmission rate was higher in ESRD versus non‐CKD patients (17.8% vs. 10.4%, OR: 2.24 [95% CI: 1.30–3.87]) as was 90‐day readmission (41.2% vs. 21% OR: 2.51 [95% CI:1.70–3.72]). Kidney function improved in 25% of patients with CKD stage 3 and in 50% with CKD stage 4–5 at 30‐and 90‐day readmission. Incidence of AKI, major bleeding, and respiratory failure were higher in CKD group. Conclusions Patients with CKD and ESRD have worse outcomes and higher readmission rate after TMVR. In patients who were readmitted after TMVR, renal function improved in some patients, suggesting that TMVR could potentially improve CKD stage.

Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Impact of chronic kidney disease on in‐hospital outcomes and readmission rate after edge‐to‐edge transcatheter mitral valve repair

Sawalha

Al‐Akchar

Ibrahim

et al. 2020

“…The current study shows that rates of readmission increase with worsening preprocedural kidney function, ESRD patients having the highest readmission rates, with heart failure followed by arrhythmias being the most common cardiac causes for readmissions in all three groups which is consistent with previous studies. [30][31][32] AKI was a significant cause of 30 day readmission in CKD group compared to no-CKD group, again underscoring the potential of the procedure itself causing acute renal dysfunction in CKD group. We also found higher rates of SNF discharge with worsening baseline kidney function.…”

Section: Discussionmentioning

confidence: 94%

Association of baseline kidney disease with outcomes of transcatheter mitral valve repair by MitraClip

Raheja

Ahuja

Nazir

et al. 2020

Objectives This study sought to determine the impact of baseline chronic kidney disease (CKD) on in‐hospital outcomes of transcatheter mitral valve repair with MitraClip (MC). Background MC is now an established treatment in high surgical risk patients. However, limited data are available on outcomes of MC in patients with baseline renal dysfunction. Methods The authors used data from January 2014 to December 2017 National Readmission Database to identify all patients ≥18 years of age who underwent MC. International classification of diseases (ICD)‐9 and ICD‐10 codes were used to identify patients with no‐CKD, CKD (without chronic dialysis), or end‐stage renal disease (ESRD) on dialysis. Multivariable logistic regression models were constructed using generalized estimating equations to examine in‐hospital outcomes. Results Of 13,563 patients undergoing MC, 8,935 (65.8%) had no‐CKD, 4,152 (30.6%) had CKD, and 476 (3.5%) had ESRD. ESRD patients compared to CKD and no‐CKD had significantly higher mortality (7.2% vs. 2.5% vs. 2.0%; p < .001), higher incidence of bleeding, blood transfusions, and 30 day all cause readmission. CKD patients compared to no‐CKD had significantly higher mortality (odds ratio‐1.29; CI 1.01–1.65; p = .04), acute kidney injury (odds ratio‐3.0; CI 2.69–3.34; p < .001), new in‐hospital hemodialysis (odds ratio‐ 2.70; CI 1.57–4.62; p < .001), blood transfusions, 30 day all cause and congestive heart failure (CHF) readmissions. In‐hospital stroke and cardiac tamponade did not differ between the three groups. Patients with baseline kidney disease undergoing MC had higher mortality at high volume centers compared to low volume centers. CHF was the most common cause of readmission postMC in patients with or without preprocedural kidney disease. Conclusion Patients with baseline kidney disease have worse outcomes after MC with higher readmission rates requiring careful patient selection and follow up in this population.

“…We examined the association between SB and outcomes using multivariable logistic regression models after multiple imputations for missing value on type of admission. For these analyses, we used weighted values to present national estimates, similar to previous NRD studies 11,12 . In contrast, we examined the association between annual hospital volume and the incidence of SB using the unweighted values.…”

Section: Methodsmentioning

confidence: 99%

Incidence and short‐term outcomes of surgical bailout after transcatheter mitral valve repair with the MitraClip system

Isogai

Saad

Shekhar

et al. 2020

Objectives This study sought to investigate the incidence and outcomes of surgical bailout (SB) after transcatheter mitral valve repair (TMVr) with MitraClip. Background TMVr poses a risk of serious procedural complications, possibly requiring urgent open surgery for SB. However, little is known about the risk of SB cases after TMVr. Methods We retrospectively identified patients who underwent TMVr using the Nationwide Readmissions Database 2014–2017. SB was defined as open thoracotomy for heart and aorta during the same hospitalization. Annual hospital volume was defined as the annual number of TMVr cases in each hospital in each year. Results Among 15,032 eligible patients, SB was required in 214 (1.42%), of whom 134 (62.6%) underwent mitral valve surgery (113 replacements; 21 repairs). The incidence of SB was decreasing significantly over the 4 years (5.26% in 2014; 0.43% in 2017; ptrend < .001). There was a significant nonlinear, inverse association of annual hospital volume with the incidence of SB. In‐hospital death (15.0 vs. 2.1%; p < .001) and other in‐hospital adverse events were significantly more frequent in patients with than without SB, whereas the 30‐day readmission rate was similar (13.2 vs. 15.1%; p = .572). After adjustment for patient and hospital characteristics, SB was significantly associated with higher in‐hospital mortality (odds ratio = 6.67, 95% confidence interval = 4.35, 10.23, p < .001). Conclusions This study suggests that although the incidence of SB after TMVr is decreasing, SB is required more frequently in lower‐volume hospitals and carries high in‐hospital mortality. Further efforts are needed to understand the reasons for SB and improve outcomes in patients needing SB.