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

Christian Torres; Mathew R. Lozier; Charles J. Davidson; Gorav Ailawadi; Marissa Donatelle; Karthik Vedantam; Susheel K. Kodali; Martin B. Leon; Nirat Beohar

doi:10.1016/j.jscai.2022.100414

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

Christian Torres, Mathew R. Lozier, Charles J. Davidson, Gorav Ailawadi, Marissa Donatelle, Karthik Vedantam, Susheel K. Kodali, Martin B. Leon, Nirat Beohar^*

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

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.

Original language	English (US)
Article number	100414
Journal	Journal of the Society for Cardiovascular Angiography and Interventions
Volume	1
Issue number	5
DOIs	https://doi.org/10.1016/j.jscai.2022.100414
State	Published - Sep 1 2022

Funding

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The research reported has adhered to the relevant ethical guidelines.

Keywords

hospital cost
length of stay
major bleeding
mortality
transcatheter tricuspid valve repair
tricuspid regurgitation

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jscai.2022.100414

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Torres, C., Lozier, M. R., Davidson, C. J., Ailawadi, G., Donatelle, M., Vedantam, K., Kodali, S. K., Leon, M. B., & Beohar, N. (2022). In-Hospital Outcomes of Transcatheter Tricuspid Valve Repair: An Analysis From the National Inpatient Sample. Journal of the Society for Cardiovascular Angiography and Interventions, 1(5), Article 100414. https://doi.org/10.1016/j.jscai.2022.100414

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

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",

author = "Christian Torres and Lozier, {Mathew R.} and Davidson, {Charles J.} and Gorav Ailawadi and Marissa Donatelle and Karthik Vedantam and Kodali, {Susheel K.} and Leon, {Martin B.} and Nirat Beohar",

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doi = "10.1016/j.jscai.2022.100414",

language = "English (US)",

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T1 - In-Hospital Outcomes of Transcatheter Tricuspid Valve Repair

T2 - An Analysis From the National Inpatient Sample

AU - Torres, Christian

AU - Lozier, Mathew R.

AU - Davidson, Charles J.

AU - Ailawadi, Gorav

AU - Donatelle, Marissa

AU - Vedantam, Karthik

AU - Kodali, Susheel K.

AU - Leon, Martin B.

AU - Beohar, Nirat

PY - 2022/9/1

Y1 - 2022/9/1

N2 - 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.

AB - 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.

KW - hospital cost

KW - length of stay

KW - major bleeding

KW - mortality

KW - transcatheter tricuspid valve repair

KW - tricuspid regurgitation

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

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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