Aleksander Dokollari, Serge Sicouri, Roberto Rodriguez, Eric Gnall, Paul Coady, Farah Mahmud, Stephanie Kjelstrom, Georgia Montone, Yoshiyuki Yamashita, Jarrett Harish, Beatrice Bacchi, Rakesh C Arora, Ashish Shah, Nitin Ghorpade, Sandra Abramson, Katie Hawthorne, Scott Goldman, William Gray, Francesco Cabrucci, Massimo Bonacchi, Basel Ramlawi
{"title":"接受经导管边缘到边缘修补术治疗二尖瓣反流的心衰患者的临床疗效和成本分析。","authors":"Aleksander Dokollari, Serge Sicouri, Roberto Rodriguez, Eric Gnall, Paul Coady, Farah Mahmud, Stephanie Kjelstrom, Georgia Montone, Yoshiyuki Yamashita, Jarrett Harish, Beatrice Bacchi, Rakesh C Arora, Ashish Shah, Nitin Ghorpade, Sandra Abramson, Katie Hawthorne, Scott Goldman, William Gray, Francesco Cabrucci, Massimo Bonacchi, Basel Ramlawi","doi":"10.3390/jpm14090978","DOIUrl":null,"url":null,"abstract":"<p><p><i>Objective:</i> To analyze the clinical and cost outcomes of transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) in heart failure (HF) patients. <i>Methods:</i> All 162 HF patients undergoing TEER for MR between January 2019 and March 2023 were included. A propensity-adjusted analysis was used to compare 32 systolic vs. 97 diastolic vs. 33 mixed (systolic + diastolic) HF patients. Systolic, diastolic, and mixed HF patients were defined according to AHA guidelines. The primary outcome was the long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs, all-cause mortality + stroke + myocardial infarction + repeat intervention). <i>Results:</i> The mean age was 76.3 vs. 80.9 vs. 76 years old, and the mean ejection fraction (EF) was 39.5% vs. 59.8% vs. 39.7% in systolic vs. diastolic vs. mixed HF, respectively. Postoperatively, the diastolic vs. systolic HF group had a higher intensive care unit stay (21 vs. 0 h; HR 67.5 (23.7, 111.4)]; lower ventilation time [2 vs. 2.3 h; HR 49.4 (8.6, 90.2)]; lower EF [38% vs. 58.5%; HR 9.9 (3.7, 16.1)]. In addition, the diastolic vs. mixed HF groups had a lower incidence of EF < 50% (11 vs. 27 patients; HR 6.6 (1.6, 27.3) and a lower use of dialysis (one vs. three patients; HR 18.1 (1.1, 287.3), respectively. At a mean 1.6 years follow-up, all-cause death [HR 39.8 (26.2, 60.5)], MACCEs [HR 50.3 (33.7-75.1)], and new pacemaker implantations [HR 17.3 (8.7, 34.6)] were higher in the mixed group. There was no significant total hospital cost difference among the systolic (USD 106,859) vs. diastolic (USD 91,731) vs. mixed (USD 120,522) HF groups (<i>p</i> = 0.08). <i>Conclusions:</i> TEER for MR evidenced the worst postoperative and follow-up clinical outcomes in the mixed HF group compared to diastolic and systolic HF groups. 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A propensity-adjusted analysis was used to compare 32 systolic vs. 97 diastolic vs. 33 mixed (systolic + diastolic) HF patients. Systolic, diastolic, and mixed HF patients were defined according to AHA guidelines. The primary outcome was the long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs, all-cause mortality + stroke + myocardial infarction + repeat intervention). <i>Results:</i> The mean age was 76.3 vs. 80.9 vs. 76 years old, and the mean ejection fraction (EF) was 39.5% vs. 59.8% vs. 39.7% in systolic vs. diastolic vs. mixed HF, respectively. Postoperatively, the diastolic vs. systolic HF group had a higher intensive care unit stay (21 vs. 0 h; HR 67.5 (23.7, 111.4)]; lower ventilation time [2 vs. 2.3 h; HR 49.4 (8.6, 90.2)]; lower EF [38% vs. 58.5%; HR 9.9 (3.7, 16.1)]. In addition, the diastolic vs. mixed HF groups had a lower incidence of EF < 50% (11 vs. 27 patients; HR 6.6 (1.6, 27.3) and a lower use of dialysis (one vs. three patients; HR 18.1 (1.1, 287.3), respectively. At a mean 1.6 years follow-up, all-cause death [HR 39.8 (26.2, 60.5)], MACCEs [HR 50.3 (33.7-75.1)], and new pacemaker implantations [HR 17.3 (8.7, 34.6)] were higher in the mixed group. There was no significant total hospital cost difference among the systolic (USD 106,859) vs. diastolic (USD 91,731) vs. mixed (USD 120,522) HF groups (<i>p</i> = 0.08). <i>Conclusions:</i> TEER for MR evidenced the worst postoperative and follow-up clinical outcomes in the mixed HF group compared to diastolic and systolic HF groups. 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引用次数: 0
摘要
目的:分析经导管边缘到边缘修补术(TEER)治疗心力衰竭(HF)患者二尖瓣反流(MR)的临床效果和成本。方法:纳入2019年1月至2023年3月期间接受TEER治疗MR的所有162名HF患者。采用倾向调整分析比较 32 名收缩期与 97 名舒张期与 33 名混合型(收缩期+舒张期)HF 患者。收缩期、舒张期和混合型心房颤动患者是根据 AHA 指南定义的。主要结果是全因死亡和主要不良心脑血管事件(MACCEs,全因死亡+中风+心肌梗死+重复干预)的长期发生率。结果显示平均年龄为 76.3 岁 vs. 80.9 岁 vs. 76 岁,平均射血分数(EF)分别为 39.5% vs. 59.8% vs. 39.7%,收缩型心房颤动 vs. 舒张型心房颤动 vs. 混合型心房颤动。术后,舒张性 HF 组与收缩性 HF 组在重症监护室的住院时间较长(21 小时 vs. 0 小时;HR 67.5 (23.7, 111.4));通气时间较短(2 小时 vs. 2.3 小时;HR 49.4 (8.6, 90.2));EF 较低(38% vs. 58.5%;HR 9.9 (3.7, 16.1))。此外,舒张组与混合型心房颤动组的 EF < 50% 发生率较低(11 名患者对 27 名患者;HR 6.6(1.6,27.3)),透析使用率较低(1 名患者对 3 名患者;HR 18.1(1.1,287.3))。在平均 1.6 年的随访中,混合组的全因死亡[HR 39.8 (26.2, 60.5)]、MACCE[HR 50.3 (33.7-75.1)] 和新起搏器植入[HR 17.3 (8.7, 34.6)]率较高。收缩期(106,859 美元)与舒张期(91,731 美元)与混合型(120,522 美元)HF 组的住院总费用无明显差异(P = 0.08)。结论:与舒张型和收缩型心房颤动组相比,混合型心房颤动组 MR TEER 的术后和随访临床结果最差。住院总费用无差异。
Clinical Outcomes and Cost Analysis in Patients with Heart Failure Undergoing Transcatheter Edge-to-Edge Repair for Mitral Valve Regurgitation.
Objective: To analyze the clinical and cost outcomes of transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) in heart failure (HF) patients. Methods: All 162 HF patients undergoing TEER for MR between January 2019 and March 2023 were included. A propensity-adjusted analysis was used to compare 32 systolic vs. 97 diastolic vs. 33 mixed (systolic + diastolic) HF patients. Systolic, diastolic, and mixed HF patients were defined according to AHA guidelines. The primary outcome was the long-term incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCEs, all-cause mortality + stroke + myocardial infarction + repeat intervention). Results: The mean age was 76.3 vs. 80.9 vs. 76 years old, and the mean ejection fraction (EF) was 39.5% vs. 59.8% vs. 39.7% in systolic vs. diastolic vs. mixed HF, respectively. Postoperatively, the diastolic vs. systolic HF group had a higher intensive care unit stay (21 vs. 0 h; HR 67.5 (23.7, 111.4)]; lower ventilation time [2 vs. 2.3 h; HR 49.4 (8.6, 90.2)]; lower EF [38% vs. 58.5%; HR 9.9 (3.7, 16.1)]. In addition, the diastolic vs. mixed HF groups had a lower incidence of EF < 50% (11 vs. 27 patients; HR 6.6 (1.6, 27.3) and a lower use of dialysis (one vs. three patients; HR 18.1 (1.1, 287.3), respectively. At a mean 1.6 years follow-up, all-cause death [HR 39.8 (26.2, 60.5)], MACCEs [HR 50.3 (33.7-75.1)], and new pacemaker implantations [HR 17.3 (8.7, 34.6)] were higher in the mixed group. There was no significant total hospital cost difference among the systolic (USD 106,859) vs. diastolic (USD 91,731) vs. mixed (USD 120,522) HF groups (p = 0.08). Conclusions: TEER for MR evidenced the worst postoperative and follow-up clinical outcomes in the mixed HF group compared to diastolic and systolic HF groups. No total hospital cost differences were observed.
期刊介绍:
Journal of Personalized Medicine (JPM; ISSN 2075-4426) is an international, open access journal aimed at bringing all aspects of personalized medicine to one platform. JPM publishes cutting edge, innovative preclinical and translational scientific research and technologies related to personalized medicine (e.g., pharmacogenomics/proteomics, systems biology). JPM recognizes that personalized medicine—the assessment of genetic, environmental and host factors that cause variability of individuals—is a challenging, transdisciplinary topic that requires discussions from a range of experts. For a comprehensive perspective of personalized medicine, JPM aims to integrate expertise from the molecular and translational sciences, therapeutics and diagnostics, as well as discussions of regulatory, social, ethical and policy aspects. We provide a forum to bring together academic and clinical researchers, biotechnology, diagnostic and pharmaceutical companies, health professionals, regulatory and ethical experts, and government and regulatory authorities.