Author + information
- 1North Shore University Hospital- Northwell Health, Manhasset, New York, United States
- 2Rutgers New Jersey Medical School, Newark, New Jersey, United States
- 3Northshore University Hospital, Manhasset, New York, United States
- 4New York Methodist Hospital, Brooklyn, New York, United States
- 5Detroit Medical center/Wayne State University Hospital, Detroit, New Jersey, United States
- 6Hofstra Northwell School of Medicine, New York, Manhasset, New York, United States
Transcatheter mitral valve repair (TMVR) is an emerging new treatment option in patients with mitral regurgitation considered a high risk for surgery. However, there is a lack of data on outcomes comparing TMVR and surgical mitral valve repair (SMVR) in advance kidney disease patients. Hence, the aim of our study was to compare the in-hospital morbidity and mortality in advance kidney disease patients undergoing TMVR or SMVR.
National Inpatient Sample (NIS) (2012- 2014) using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes 35.97 for TMVR and 35.12 for SMVR was used to form a database. Patients with chronic kidney disease stage IV, Stage V and end stage renal disease (ESRD) based on ICD-9 diagnostic codes were included as advanced kidney disease patients. The primary outcome was in-hospital mortality.
A total of 2,197 (Weighted 10,985) patients were studied. The mean age was higher with the TMVR group (72.4 vs 61.7, p=<0.0001). After performing multivariate regression analysis, the primary outcome of in-hospital mortality (13.8% vs 1.3%, adjusted p=0.0030) and all secondary outcomes, excluding dialysis requirement, cardiogenic shock and cardiac arrest were significantly lower with the TMVR approach. The average length of stay was lower with TMVR when compared to SMVR (22.8 vs 12.6 days, adjusted p=0.0003), with reduced in-hospital costs ($98,165 vs $52,646, adjusted p=<0.0001).
These results demonstrate TMVR is associated with significantly lower inpatient morbidity and mortality in patients with advanced kidney disease compared to SMVR in this large national study.
STRUCTURAL: Valvular Disease: Mitral