Surgical versus Interventional Mitral Valve Repair: Analysis of 1,100 Propensity Score-Matched Patients

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiac Surgery Pub Date : 2023-10-06 DOI:10.1155/2023/8838005
Andrea Amabile, Brandon Muncan, Arnar Geirsson, Andreas P. Kalogeropoulos, Markus Krane
{"title":"Surgical versus Interventional Mitral Valve Repair: Analysis of 1,100 Propensity Score-Matched Patients","authors":"Andrea Amabile, Brandon Muncan, Arnar Geirsson, Andreas P. Kalogeropoulos, Markus Krane","doi":"10.1155/2023/8838005","DOIUrl":null,"url":null,"abstract":"Objective. We aimed to investigate outcomes in transcatheter versus surgical mitral valve repair in patients with secondary mitral regurgitation (MR) by leveraging a global, multi-institutional federated network database. Methods. Using validated ICD-10 and CPT codes, the TriNetX Analytics Research Data Network (a global federated database of electronic health records from 58 healthcare organizations) was queried to identify patients diagnosed with chronic, severe, ischemic MR and undergoing either transcatheter mitral valve repair (TMVr) or surgical mitral valve repair (SMVr) between January 1, 2015 and December 31, 2020. To adjust for baseline differences, 1 : 1 propensity score matching was performed via logistic regression using the nearest-neighbor approach and matching for 29 covariates including demographics, comorbidities, surgical history, preoperative medications, left ventricular function and heart failure status. We compared 1- and 3-year mortality rates and 1- and 3-year mitral valve reoperation rates in the matched cohorts using Kaplan-Meier estimates and adjusted Cox proportional hazards models. Results. A total of 2,352 patients met inclusion criteria (1,392 in the surgical mitral valve repair group and 960 in the TMVr group). After 1 : 1 propensity score matching, a total of 550 patients undergoing surgical mitral valve repair (SMVr) were compared to 550 patients undergoing TMVr. All characteristics were adequately matched between the cohorts (standardized mean difference <0.1). At 1- and 3-years respectively, mortality rate was 13.4% and 20.7% for surgical patients and 19.8% and 40.3% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to face mortality at 3 years (HR: 0.42, 95% CI: 0.31–0.56, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mtext> </mtext> <mo><</mo> <mtext> </mtext> <mn>0.0001</mn> </math> ). At 1- and 3-years respectively, mitral valve reoperation was 2.2%, and 2.4% for surgical patients and 6.6% and 7.8% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to undergo mitral valve reintervention at 3 years (HR: 0.29, 95% CI: 0.14–0.58, p = 0.0002). Conclusion. In a real-world, propensity score matching analysis of a large cohort of patients with chronic ischemic MR, surgical mitral valve repair had significantly better survival rates and significantly lower reintervention rates at 1- and 3-years compared to TMVr.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.3000,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiac Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/2023/8838005","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Objective. We aimed to investigate outcomes in transcatheter versus surgical mitral valve repair in patients with secondary mitral regurgitation (MR) by leveraging a global, multi-institutional federated network database. Methods. Using validated ICD-10 and CPT codes, the TriNetX Analytics Research Data Network (a global federated database of electronic health records from 58 healthcare organizations) was queried to identify patients diagnosed with chronic, severe, ischemic MR and undergoing either transcatheter mitral valve repair (TMVr) or surgical mitral valve repair (SMVr) between January 1, 2015 and December 31, 2020. To adjust for baseline differences, 1 : 1 propensity score matching was performed via logistic regression using the nearest-neighbor approach and matching for 29 covariates including demographics, comorbidities, surgical history, preoperative medications, left ventricular function and heart failure status. We compared 1- and 3-year mortality rates and 1- and 3-year mitral valve reoperation rates in the matched cohorts using Kaplan-Meier estimates and adjusted Cox proportional hazards models. Results. A total of 2,352 patients met inclusion criteria (1,392 in the surgical mitral valve repair group and 960 in the TMVr group). After 1 : 1 propensity score matching, a total of 550 patients undergoing surgical mitral valve repair (SMVr) were compared to 550 patients undergoing TMVr. All characteristics were adequately matched between the cohorts (standardized mean difference <0.1). At 1- and 3-years respectively, mortality rate was 13.4% and 20.7% for surgical patients and 19.8% and 40.3% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to face mortality at 3 years (HR: 0.42, 95% CI: 0.31–0.56, p < 0.0001 ). At 1- and 3-years respectively, mitral valve reoperation was 2.2%, and 2.4% for surgical patients and 6.6% and 7.8% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to undergo mitral valve reintervention at 3 years (HR: 0.29, 95% CI: 0.14–0.58, p = 0.0002). Conclusion. In a real-world, propensity score matching analysis of a large cohort of patients with chronic ischemic MR, surgical mitral valve repair had significantly better survival rates and significantly lower reintervention rates at 1- and 3-years compared to TMVr.
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
手术与介入二尖瓣修复:1100名倾向评分匹配患者的分析
目标。我们旨在通过利用全球多机构联合网络数据库,研究经导管与手术二尖瓣修复继发性二尖瓣反流(MR)患者的结果。方法。使用经过验证的ICD-10和CPT代码,查询TriNetX分析研究数据网络(来自58个医疗保健组织的电子健康记录的全球联邦数据库),以确定2015年1月1日至2020年12月31日期间诊断为慢性,严重,缺血性MR并接受经导管二尖瓣修复(TMVr)或手术二尖瓣修复(SMVr)的患者。为了调整基线差异,采用最近邻方法,通过logistic回归进行1:1倾向评分匹配,并匹配29个协变量,包括人口统计学、合并症、手术史、术前用药、左心室功能和心力衰竭状态。我们使用Kaplan-Meier估计和调整的Cox比例风险模型比较了匹配队列中1年和3年死亡率以及1年和3年二尖瓣再手术率。结果。共有2352例患者符合纳入标准(手术二尖瓣修复组1392例,TMVr组960例)。1:1倾向评分匹配后,550例接受外科二尖瓣修复(SMVr)的患者与550例接受TMVr的患者进行比较。所有特征在队列之间充分匹配(标准化平均差<0.1)。手术患者1年和3年的死亡率分别为13.4%和20.7%,TMVr患者为19.8%和40.3%。与TMVr相比,接受SMVr的患者在3年时面临死亡率的可能性显著降低(HR: 0.42, 95% CI: 0.31-0.56, p <0.0001)。手术患者1年和3年二尖瓣再手术分别为2.2%和2.4%,TMVr患者为6.6%和7.8%。与TMVr相比,接受SMVr的患者在3年时进行二尖瓣再干预的可能性显著降低(HR: 0.29, 95% CI: 0.14-0.58, p = 0.0002)。结论。在现实世界中,对大量慢性缺血性MR患者进行倾向评分匹配分析,与TMVr相比,手术二尖瓣修复在1年和3年的生存率显著提高,再干预率显著降低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
2.90
自引率
12.50%
发文量
976
审稿时长
3-8 weeks
期刊介绍: Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
期刊最新文献
Chest Tube Clearance Strategies Versus Conventional Chest Tubes After Cardiac Surgery Long-Term Survival of Mitroflow and Perimount Aortic Valve Replacements Contemporary Surgical Approaches in Pediatric Aortic Valve Surgery: A Retrospective Comparison of Three Techniques Systematic Review and Meta-Analysis of Comparative Studies: Transcatheter Versus Surgical Closure for Postinfarct Ventricular Septal Defect Hypertrophic Cardiomyopathy With Elongated Mitral Valve Leaflets: Clinical Characteristics and Surgical Results
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1