Impact of Peripheral Vascular Disease After Transcatheter Mitral Valve Repair: Insights From the National Inpatient Sample
Sitammagari K, Desai R, Kondamareddy D, Ninan J, Dontaraju V, R. DB, and Villablanca P. Impact of Peripheral Vascular Disease After Transcatheter Mitral Valve Repair: Insights From the National Inpatient Sample. JACC: Cardiovasc Interv 2020; 13(4):S59.
JACC: Cardiovasc Interv
Background: Peripheral vascular disease (PVD) is an independent predictor of poor outcomes after cardiovascular interventions and surgeries. Association of PVD with in-hospital outcomes after transcatheter mitral valve repair (TMVr) has not been studied. Methods: Adults who underwent TMVr procedures from January 2011 to September 2015 were identified using the National Inpatient Sample. ICD-9 codes were used to differentiate PVD versus non-PVD patients. Multivariate linear and logistic regressions were used to calculate odds ratios for primary and secondary outcomes while adjusting for confounders. Results: A total of 5,093 patients underwent TMVr procedure, of which 618 (12.1%) had documented PVD. Patients with PVD were more likely older, male and smokers with comorbidities including hypertension, diabetes, dyslipidemia, previous myocardial infarction, previous coronary bypass surgery, chronic pulmonary disease, liver disease, renal failure, hemodialysis status and coagulopathy (p<0.05 for all). Patients with PVD had lower odds of all-cause in-hospital mortality (aOR 0.35, p=0.031) and postoperative infection (aOR 0.31, p=0.009) compared to non-PVD patients. Higher odds of pacemaker requirement (aOR 2.52, p<0.001), pericardial complications (aOR 3.23, p<0.001), perioperative stroke (aOR 22.36, p<0.001), mechanical ventilation (aOR 1.51, p=0.011) and venous thromboembolism (VTE) (aOR 4.28, p<0.001) were noted in PVD patients. PVD patients demonstrated comparable length of hospital stay but higher hospital charges. Conclusion: Presence of PVD marginally lowered the odds of mortality, iatrogenic cardiac complications, and infection after TMVr. However, these patients are at increased risk of pacemaker requirement, stroke, pericardial complications, mechanical ventilation and VTE.