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Feasibility and predictors of early discharge after percutaneous edge-to-edge mitral valve repair
  1. Corrado Tamburino,
  2. Sergio Buccheri,
  3. Antonio Popolo Rubbio,
  4. Salvatore Scandura,
  5. Maria Elena Di Salvo,
  6. Sarah Mangiafico,
  7. Sebastiano Immé,
  8. Giuseppe Caruso,
  9. Matteo Scalia,
  10. Antonio Condorelli,
  11. Marco Barbanti,
  12. Piera Capranzano,
  13. Davide Capodanno,
  14. Carmelo Grasso
  1. Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
  1. Correspondence to Professor Davide Capodanno, Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Via Citelli 6, Catania 95100, Italy; dcapodanno{at}gmail.com

Abstract

Background Percutaneous edge-to-edge mitral valve repair (PMVR) recently emerged as an effective treatment modality for patients with severe mitral regurgitation (MR). Length of postprocedural hospital stay may represent a modifiable cost associated with percutaneous treatment. We looked at feasibility, predictors and safety of early discharge (ED), defined as hospital discharge within 72 hours, in patients undergoing PMVR.

Methods and results Consecutive patients treated with MitraClip from October 2008 to December 2015 were analysed. Primary outcomes of interest were cardiovascular and non-cardiovascular mortality, rehospitalisation for heart failure and major adverse events at 30 days and 90 days. A total of 269 patients were included. Of these, 115 patients were early discharged (ED group). Rates of ED increased from 25.9% for the biennium 2008–2009 to 59.1% in 2014–2015 (p<0.001 for trend). In a penalised logistic regression model, male gender (OR=2.13, 95% CI 1.17 to 3.95) and procedural year (OR=2.13, 95% CI 1.51 to 3.11) were associated with higher probability of ED. Conversely, atrial fibrillation (OR=0.48, 95% CI 0.27 to 0.85), any Mitral Valve Academic Research Consortium bleeding (OR=0.07, 95% CI 0.01 to 0.60), log-transformed N-terminal pro-brain natriuretic peptide levels (OR=0.79, 95% CI 0.63 to 0.99) and postimplant MR grade (OR=0.60, 95% CI 0.37 to 0.94) conferred a lower likelihood of ED. In propensity score-weighted analyses, overall survival, freedom from heart failure and major adverse events at 30 days and 90 days were not different in ED and non-ED groups (all weighted log-rank p value>0.05).

Conclusions In selected patients undergoing PMVR, ED may be feasible and safe.

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Footnotes

  • Contributors SB and DC drafted the manuscript. All authors have contributed to critically reviewing the paper.

  • Competing interests CG is a proctor physician for Abbott Vascular. DC and CT received consulting honoraria from Abbott Vascular.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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