Author + information
- 1Lenox Hill Hospital, New York, New York, United States
- 2University of California Irvine, Orange, California, United States
- 3David Geffen School of Medicine at UCLA, LOS ANGELES, California, United States
- 4David Geffen School of Medicine UCLA & Veteran's Administration, Los Angeles, California, United States
Percutaneous mitral valve repair (Mitraclip) has been demonstrated to provide a suitable minimally invasive treatment modality for patients with severe mitral regurgitation and high surgical risk. In this analysis we compare mortality, cost, and impact on 30-day readmission between percutaneous and conventional mitral repair in clinical practice.
Patients undergoing isolated mitral valve repair or mitral clip in the 2011-2014 National Readmission Database (NRD) were identified using ICD-9 CM procedure codes. The NRD is an all-payer inpatient database with discharge data from 1,045 hospitals in the United States sponsored by the Agency for Healthcare Research and Quality. Mortality, readmission, and cost were evaluated using multilevel linear regression to control for patient-level demographics and comorbidities measured by Elixhauser Index, and hospital factors.
2,751 percutaneous and 43,690 conventional repairs were performed during the study period. Patients undergoing percutaneous modality were more likely male (56% vs 43%, P<0.001), to have Medicare (74% vs 56%, P<0.001), elderly (73 vs 64 years, P<0.001), with similar Elixhauser Comorbidity Index (5.5 vs 5.7, P=0.10). Percutaneous repair was associated with lower adjusted mortality at discharge (3.6% vs 5.0% OR=0.54, P<0.001), lower cost of surgery ($49,564 vs $65,105, β=-0.38, P<0.001), and shorter index stay (7.9 vs 14.4 days, IRR=0.58, P<0.001). 30-day readmission rate in percutaneous patients, most commonly for atrial fibrillation (6.8%), was significantly lower (14.7% vs 19.1%, OR=0.77, P<0.002).
In this study of 46,441 U.S. patients who underwent mitral repair from 2011-2014, the percutaneous approach was 24% less expensive, had 23% lower odds of readmission within 30-days, 45% shorter length of stay, and 28% lower odds of mortality. Based on our findings, investigation of percutaneous mitral repair in lower risk cohort patients is warranted to assess durability and improvements in cardiac function.
STRUCTURAL: Valvular Disease: Mitral