In-Hospital Outcomes of Patients With Paroxysmal versus Persistent Atrial Fibrillation Undergoing Percutaneous Mitral Valve Repair
Presenter
Genaro Velazquez, MD, Cook County Health, CHICAGO, IL
Genaro Velazquez, MD1, Bertrand F Ebner, MD2, Jelani K Grant, MD3, Louis Vincent, MD2, Jennifer Maning4, Neal Olarte, DO5, Juan Del Cid Fratti MD MS, MD MSc6, Odunayo Olorunfemi7, Rosario Colombo, MD8 and Carlos E. Alfonso, M.D., FSCAI9, (1)Cook County Health, CHICAGO, IL, (2)-, Miami, FL, (3)Jackson Memorial Hospital, Miami, FL, (4)University of Miami/Jackson Memorial Medical Center, Miami, FL, (5)University of Miami Miller School of Medicine, Miami, FL, (6)The University of Washington, Peoria, IL, (7)University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami Beach, FL, (8)University Of Miami Miller School Of Medicine, Pinecrest, FL, (9)University of Miami Miller School of Medicine, Coral Gables, FL
Keywords: TEER/TMVR/Mitral Valve
Background:
Percutaneous therapy has emerged and expanded as an option for treatment of mitral valve disease for selected patients at predominately high-risk as a result of coexisting comorbidities such as heart failure, chronic kidney disease, atrial fibrillation (AF), amongst others. In this study, we determined the in-hospital outcomes of paroxysmal versus persistent AF in patients undergoing percutaneous mitral valve repair (PMVR).
Methods:
Using the National Inpatient Sample (NIS) database we identified patients with a history of paroxysmal AF or persistent AF who underwent PMVR from 2015 to 2017. Patients were identified using ICD-10-CM/PCS codes: I48.0 for paroxysmal AF, I48.1 for persistent AF and 02UG3JZ for PMVR. Individuals who had both diagnoses, paroxysmal and persistent AF, were excluded (n=12). No patients were identified with permanent Afib (ICD-10-CM code I48.2). The primary outcome was post-PMVR all-cause inpatient mortality. Secondary outcomes of interest included in-hospital complications. Multivariate regression analysis was performed to adjust for significant different comorbidities.
Results:
A total weighted estimate of 2,530 patients with paroxysmal or persistent AF underwent PMVR. Patients with paroxysmal AF accounted for 79% (n=2,000) of the cohort. Compared with patients with persistent AF, patients with paroxysmal AF had higher rates of in-hospital unadjusted mortality (3% vs 0%; p <0.001), but no difference was found on multivariate analysis (p=0.997). Patients with paroxysmal AF had statistically significant higher odds of acute coronary syndrome and acute kidney injury, but decreased odds of post-operative infection, major bleeding and ventricular fibrillation/flutter in comparison to patients with persistent AF (p<0.05 for all).
Conclusions:
Although the odds for complications varies depending on classification of paroxysmal or persistent AF, PMVR is a safe procedure with low rates of complications irrespective of the type of AF.