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. 2022 Aug 4;1(5):100414.
doi: 10.1016/j.jscai.2022.100414. eCollection 2022 Sep-Oct.

In-Hospital Outcomes of Transcatheter Tricuspid Valve Repair: An Analysis From the National Inpatient Sample

Christian Torres  1 , Mathew R Lozier  1 , Charles J Davidson  2 , Gorav Ailawadi  3 , Marissa Donatelle  4 , Karthik Vedantam  1 , Susheel K Kodali  5   6 , Martin B Leon  5   6 , Nirat Beohar  1
Affiliations

In-Hospital Outcomes of Transcatheter Tricuspid Valve Repair: An Analysis From the National Inpatient Sample

Christian Torres et al. J Soc Cardiovasc Angiogr Interv. .

Abstract

Background: Patients with severe tricuspid regurgitation carry an elevated surgical risk resulting in increasing adoption of less invasive transcatheter therapies such as transcatheter tricuspid valve repair (TTVR); however, data are limited. This study aimed to describe patient characteristics and predictors of poor outcomes among those undergoing TTVR.

Methods: The National Inpatient Sample was queried (2016-2019) to identify all patients undergoing TTVR (International Classification of Diseases, Tenth Revision code 02UJ3JZ) alone or in combination with mitral transcatheter edge-to-edge repair (MTEER) (code 02UG3JZ). The primary aim was to define clinical characteristics, time trends, in-hospital outcomes, and predictors of all-cause in-hospital mortality (mortality). The secondary outcomes included predictors of increased hospitalization costs and length of stay (greater than the 75th percentile).

Results: We identified 925 patients who underwent TTVR (460 [49.7%] who underwent TTVR alone and 465 [50.3%] who underwent TTVR in combination with MTEER). There was a 6.5-fold increase in TTVR adoption (P < .001). Patients were older (78 ± 10 years), female (63.2%), and White (72.7%), with frequent comorbidities. Mortality occurred in 2.2%, vascular complications occurred in 10.3%, and major bleeding occurred in 3.3%. The predictors of mortality were acute kidney injury (odds ratio [OR], 5.25; 95% CI, 5.24-5.26; P < .001), major bleeding (OR, 2.81; 95% CI, 2.80-2.83; P < .001), pericardiocentesis (OR, 2.15; 95% CI, 2.11-2.18; P < .001), and chronic liver disease (OR, 1.40; 95% CI, 1.39-1.40; P < .001). The predictors of increased length of stay or hospitalization costs included coronary artery disease, atrial arrhythmias, pulmonary hypertension, chronic liver disease, and procedural complications.

Conclusions: TTVR showed increased adoption with elevated but acceptable mortality and complications considering this high-risk population. The results of randomized trials are awaited.

Keywords: hospital cost; length of stay; major bleeding; mortality; transcatheter tricuspid valve repair; tricuspid regurgitation.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Patient selection flow chart. MTEER, mitral valve transcatheter edge-to-edge repair; NIS, National Inpatient Sample; TTVR, transcatheter tricuspid valve repair.
Central Illustration
Central Illustration
Transcatheter tricuspid valve repair: trends, length of stay, and hospitalization costs. (A) Trend in number of isolated TTVR or in combination with MTEER procedures performed yearly. There was an increase in the numbers of TTVR performed yearly since 2016 across both groups, with most of the interventions being performed in 2019. (B) Trends in hospitalization costs among patients who underwent TTVR. Hospitalizations costs have remained relatively unchanged. (C) Trends in hospital length of stay among patients who underwent TTVR. There was a downward trend in the length of hospitalization during our study period; however, this did not reach statistical significance. MTEER, mitral valve transcatheter edge-to-edge repair; TTVR, transcatheter tricuspid valve repair.
Figure 2
Figure 2
Trends in the number of TTVR by sex. Trends in the number of TTVR procedures performed yearly (2016-2019) stratified by sex. TTVR has progressively increased across both sexes; however, it appears that females are more likely to undergo this procedure. TTVR, transcatheter tricuspid valve repair.
Figure 3
Figure 3
Trends in number of TTVR across ethnicities. Trends in the number of TTVR procedures performed yearly (2016-2019) stratified by ethnicities. TTVR has progressively increased across all ethnicities; however, there appears to be a greater adoption among Whites than among other racial minorities. TTVR, tricuspid valve repair.
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References

    1. Singh J.P., Evans J.C., Levy D., et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study) Am J Cardiol. 1999;83(6):897–902. - PubMed
    1. Baumgartner H., Falk V., Bax J.J., et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Rev Esp Cardiol (Engl Ed) 2018;71(2):110. - PubMed
    1. Otto C.M., Nishimura R.A., Bonow R.O., et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2021;143(5):e35–e71. - PubMed
    1. Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality. https://www.ahrq.gov/data/hcup/index.html Accessed April 22, 2022. - PubMed
    1. Elixhauser A., Steiner C., Harris D.R., Coffey R.M. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27. - PubMed

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