Predicting the Need for Intensive Care Unit Treatment After Successful Transcatheter Edge-to-Edge Mitral Valve Repair

TL;DR

This study identifies factors that predict the need for ICU care after a heart valve repair procedure, which can help improve patient outcomes.

Contribution

The study identifies novel predictors for ICU treatment after M-TEER, enabling tailored treatment strategies.

Findings

33% of M-TEER patients required ICU treatment, with significantly lower 3-year survival rates.

EuroSCORE II >10%, MitraScore >3, and hospital stay >5 days were independent predictors of ICU need.

ICU treatment was associated with a high mortality rate, highlighting the importance of early prediction.

Abstract

Background/Objectives: Transcatheter edge-to-edge mitral valve repair (M-TEER) has emerged as an efficacious treatment modality among patients at high perioperative risk. Given the steady increase in procedures and the limited capacity for intensive care, there is a need to identify patients at high risk for postinterventional intensive care. Methods: All patients who underwent M-TEER between 2014 and 2023 were investigated. The intensive care unit (ICU) stay ended when patients met all the following criteria: no further need for catecholamine support, no oxygen requirement > 6 L O2/min, no indication for renal replacement therapy, and no delirium or relevant bleeding. Uni- and multivariable logistic regression analyses were used to identify independent predictors of the need for ICU treatment. Results: In total, 33% of patients (62/183) had an indication for ICU treatment after M-TEER. Patients with an indication for ICU treatment had significantly lower survival rates three years after M-TEER (37.4% [23/62] vs. 61.6% [75/121], p < 0.001) than patients without an ICU indication. A EuroSCORE II of >10% (OR 2.6, 95% CI 1.3–5.4, p = 0.006), a MitraScore of >3 (OR 2.5, 95% CI 1.2–5.2, p = 0.02), and a hospital stay of >5 days before M-TEER (OR 3.2, 95% CI 1.6–6.4, p < 0.001) were independently associated with the need for ICU treatment. Conclusions: One-third of the patients were indicated for ICU treatment, which was associated with a high mortality rate. On the basis of these predictors of required ICU care, tailored treatment strategies can be developed to improve treatment outcomes.

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