Abstract：
BACKGROUND: A significant proportion of patients requiring mitral valve (MV) intervention have undergone prior coronary artery bypass grafting (CABG). Reoperative heart surgery is associated with increased risk.
OBJECTIVE: To evaluate the utilization and outcomes of transcatheter versus surgical MV interventions in patients with prior CABG.
METHODS: We queried the Nationwide Readmission Database (2016-2021) to identify adults with prior CABG hospitalized for transcatheter or surgical MV intervention. In-hospital outcomes were compared using multivariable regression and propensity-matching analyses. Readmissions were compared using Cox proportional hazards regression model.
RESULTS: Of 305,625 weighted hospitalizations for MV intervention, 23,506 (7.7%) occurred in patients with prior CABG. From 2016-2021, the use of transcatheter MV interventions increased among patients with prior CABG (72 to 191 for repair and 6 to 45 for replacement per 100,000 hospitalizations, both ptrend<0.001). Compared with surgical MV repair and replacement, transcatheter MV repair and replacement were associated with similar in-hospital mortality (adjusted odds ratio [aOR] 0.44, 95% confidence interval [CI] 0.20-1.03 for repair; aOR 0.61, 95% CI 0.38-1.02 for replacement) and 180-day heart failure readmissions (adjusted hazard ratio [aHR] 1.56, 95% CI 0.85-2.87 for repair; aHR 1.15, 95% CI 0.63-2.09 for replacement) and lower stroke, acute kidney injury, permanent pacemaker placement, length of stay, and nonhome discharges, respectively. Vascular complications were higher with transcatheter versus surgical MV replacement.
CONCLUSIONS: Transcatheter MV interventions are increasingly used as the preferred modality of MV intervention in patients with prior CABG and are associated with similar in-hospital mortality and 180-day heart failure readmissions compared with surgical MV interventions.
OBJECTIVE: To evaluate the utilization and outcomes of transcatheter versus surgical MV interventions in patients with prior CABG.
METHODS: We queried the Nationwide Readmission Database (2016-2021) to identify adults with prior CABG hospitalized for transcatheter or surgical MV intervention. In-hospital outcomes were compared using multivariable regression and propensity-matching analyses. Readmissions were compared using Cox proportional hazards regression model.
RESULTS: Of 305,625 weighted hospitalizations for MV intervention, 23,506 (7.7%) occurred in patients with prior CABG. From 2016-2021, the use of transcatheter MV interventions increased among patients with prior CABG (72 to 191 for repair and 6 to 45 for replacement per 100,000 hospitalizations, both ptrend<0.001). Compared with surgical MV repair and replacement, transcatheter MV repair and replacement were associated with similar in-hospital mortality (adjusted odds ratio [aOR] 0.44, 95% confidence interval [CI] 0.20-1.03 for repair; aOR 0.61, 95% CI 0.38-1.02 for replacement) and 180-day heart failure readmissions (adjusted hazard ratio [aHR] 1.56, 95% CI 0.85-2.87 for repair; aHR 1.15, 95% CI 0.63-2.09 for replacement) and lower stroke, acute kidney injury, permanent pacemaker placement, length of stay, and nonhome discharges, respectively. Vascular complications were higher with transcatheter versus surgical MV replacement.
CONCLUSIONS: Transcatheter MV interventions are increasingly used as the preferred modality of MV intervention in patients with prior CABG and are associated with similar in-hospital mortality and 180-day heart failure readmissions compared with surgical MV interventions.
摘要：
背景：需要二尖瓣（MV）介入治疗的患者中，有相当大的比例曾接受过冠状动脉旁路移植术（CABG）。心脏手术与风险增加有关。
目的：评估经导管与外科MV干预在既往CABG患者中的应用和结果。
方法：我们查询了全国再入院数据库（2016-2021年），以确定先前接受经导管或外科MV干预的CABG住院的成年人。使用多变量回归和倾向匹配分析比较住院结局。再入院采用Cox比例风险回归模型进行比较。
结果：在MV干预的305,625个加权住院治疗中，23,506（7.7％）发生在先前的CABG患者中。从2016年到2021年，在先前有CABG的患者中，经导管MV干预的使用有所增加（每100,000例住院患者中，修复72至191例，置换6至45例，两者的ptrend<0.001)。与手术MV修复和置换相比，经导管MV修复和置换与相似的住院死亡率（修复的校正比值比[aOR]0.44，95％置信区间[CI]0.20-1.03；替换的aOR0.61，95％CI0.38-1.02）和180天心力衰竭再入院（修复的校正风险比[aHR]1.56，95％CI0.85-2.87；替换的aHR1.15，95％CI0.63-2.09，更低）急性肾损伤，永久性起搏器放置,逗留时间,和非家庭排放，分别。经导管MV置换的血管并发症高于手术。
结论：经导管MV干预越来越多地用作既往CABG患者的MV干预的首选方式，与手术MV干预相比，其住院死亡率和180天心力衰竭再入院率相似。
目的：评估经导管与外科MV干预在既往CABG患者中的应用和结果。
方法：我们查询了全国再入院数据库（2016-2021年），以确定先前接受经导管或外科MV干预的CABG住院的成年人。使用多变量回归和倾向匹配分析比较住院结局。再入院采用Cox比例风险回归模型进行比较。
结果：在MV干预的305,625个加权住院治疗中，23,506（7.7％）发生在先前的CABG患者中。从2016年到2021年，在先前有CABG的患者中，经导管MV干预的使用有所增加（每100,000例住院患者中，修复72至191例，置换6至45例，两者的ptrend<0.001)。与手术MV修复和置换相比，经导管MV修复和置换与相似的住院死亡率（修复的校正比值比[aOR]0.44，95％置信区间[CI]0.20-1.03；替换的aOR0.61，95％CI0.38-1.02）和180天心力衰竭再入院（修复的校正风险比[aHR]1.56，95％CI0.85-2.87；替换的aHR1.15，95％CI0.63-2.09，更低）急性肾损伤，永久性起搏器放置,逗留时间,和非家庭排放，分别。经导管MV置换的血管并发症高于手术。
结论：经导管MV干预越来越多地用作既往CABG患者的MV干预的首选方式，与手术MV干预相比，其住院死亡率和180天心力衰竭再入院率相似。
