The following is a summary of “Valve unit instead of intensive or intermediate care unit admission following transcatheter edge-to-edge mitral valve repair is safe and reduces postprocedural complications,” published in the February 2024 issue of Cardiology by Gröger et al.
Transcatheter edge-to-edge mitral valve repair (M-TEER), typically under general anesthesia, requires post-procedural monitoring in intensive or intermediate care units (ICU/IMC).
Researchers conducted a retrospective study to assess the impact of using a dedicated valve unit (VU) instead of an ICU/IMC for post-M-TEER monitoring.
They analyzed a total of 624 patients. Of these, 312 patients were primarily transferred to either the ICU or IMC following M-TEER, while the remaining 312 patients were scheduled for the VU without indications for ICU/IMC treatment. The hospital stay exhibited a significant difference between the two groups, with VU patients showing a shorter median stay of 6.0 days (IQR 5.0 – 8.0) compared to 7.0 days (IQR 6.0 – 10.0) for ICU/IMC patients (P<0.001). VU patients had a lower risk of infections (2.9% vs 7.7%, P=0.008) and delirium (0.6% vs 2.6%, P=0.056) compared to ICU/IMC patients. In-hospital mortality rates were similar between the two groups (0.6% vs 1.3%, P=0.41).
The result showed that 50 patients (16.0%) in the VU group required unplanned crossover to ICU/IMC admission. The primary reason for this crossover was a prolonged requirement for catecholamines (52.0%). Patients who crossed over to ICU/IMC had more advanced stages of heart failure (LV-EF < 30% in 36.0 vs 16.0%, P=0.001; severe concomitant tricuspid regurgitation in 48.0 vs 27.8%, P=0.005). Additionally, severe concomitant tricuspid regurgitation was more prevalent in patients who crossed over (48.0% vs 27.8%, P=0.005). An LV-EF <30% was independently associated with unplanned ICU/IMC admission.
Investigators concluded that VU monitoring after M-TEER is safe, cuts complications, and saves ICU beds, but advanced heart failure patients may still need ICU care.
Source: link.springer.com/article/10.1007/s00392-024-02384-8