Open AccessIn‐hospital outcomes of transcatheter versus surgical mitral valve repair in patients with chronic liver disease
Author(s) -
Sawalha Khalid,
Gupta Kamesh,
Kadado Anis John,
Abozenah Mohammed,
Battisha Ayman,
Salerno Colby,
Khan Ahmad,
Islam Ashequl M.
Publication year - 2021
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.14660
Subject(s) - medicine , cirrhosis , mechanical ventilation , mitral regurgitation , cardiogenic shock , heart failure , mortality rate , blood transfusion , liver disease , cardiology , mitral valve , surgery , mitral valve repair , myocardial infarction
Background Mitral valve transcatheter edge‐to‐edge repair (TEER) using MitraClip is a treatment option for patients with moderate to severe mitral regurgitation who are not surgical candidate. Liver cirrhosis is associated with higher operative morbidity and mortality; however, it is not part of preoperative risk assessments calculators. We sought to evaluate the in‐hospital outcomes in TEER and surgical mitral valve repair (SMVR) in liver cirrhosis. Methods National Inpatient Database from 2013 to 2017 was used to obtain all patients with cirrhosis who underwent TEER or SMVR using ICD‐9‐CM and ICD‐10‐CM codes. The primary outcome is to compare inpatient mortality between TEER and SMVR. Secondary outcomes were assessed including length of stay (LOS) and rate of complications including cardiogenic shock, blood transfusion and prolonged ventilation. Results A total of 875 patients with cirrhosis who underwent TEER (n = 123) or SMVR (n = 752) were identified in our analysis. Patients with TEER had significantly higher comorbidities such as congestive heart failure, coronary artery disease and chronic obstructive pulmonary disease. In‐hospital mortality was lower in TEER group (8.2% vs 16%, P = .04). TEER was associated with lower rates of blood transfusion (30.3% vs 61.2%, P = .02) and reduced rates of prolonged mechanical ventilation (1.2% vs 17.2%, P = .042). In multivariate regression analysis, both blood transfusion and prolonged mechanical ventilation were significant predictors of mortality in liver cirrhosis. Conclusions TEER was associated with lower rate of in‐hospital mortality, LOS, blood transfusion and prolonged mechanical ventilation in cirrhosis patients. TEER can be considered as a viable option for cirrhosis patient with severe mitral regurgitation.