P5570Contemporary trends and outcomes of percutaneous and surgical mitral valve replacement or repair for mitral insufficiency in cancer patients
Authors: Guha A , Dey A , McKinley G , Jneid H , Addison D 
Published: October 2019

Abstract

Importance
Severe mitral valve insufficiency (MR) is managed using mitral valve replacement or repair. Transcatheter mitral valve repair (TMVR) is an emerging non-invasive treatment option for MR. Cancer patients stand to benefit from non-invasive treatment of MR given the nature of this intervention. Objective:We sought to assess the relative utilization, outcomes, and dispositions associated with TMVR vs. surgical mitral valve procedures (SMVP) in cancer patients.

Methods
The 2012–2015 National Inpatient Sample, a retrospective observational study was queried using ICD-9 codes for adults >18 years with comorbid MR (ICD-9 – 424.0) and cancer without metastatic disease. To maintain a homogenous study population and to limit confounding, those with mitral stenosis, rheumatic disease, infective endocarditis, aortic valve disease, or those undergoing any other vascular or cardiac surgery in the same admission were excluded from the analysis. Multiple in-hospital and disposition outcomes were evaluated. Since the baseline population undergoing SMVP (ICD-9: 35.23, 35.24, 35.12) is quite different from TMVR (ICD-9: 35.97), parallel analyses for outcomes and dispositions were presented but no direct statistical comparisons.

Results
A total of 410,175 out of 2,449,010 patients with mitral insufficiency were found to have non-metastatic cancer (16.7%). A total of 3,600 TMVR procedures were performed during the study period. Over the study period, there has been an increase in the proportion of patients undergoing TMVR among all patients undergoing mitral valve procedures (figure). The increase is higher in cancer patients in the most recent year (14.2% vs. 8.2%, p<0.0001). The four major cancers comprise of 50% of these TMVR patients. TMVR was associated with 1.4% vs. 2.2% in-hospital mortality (p=0.55), 0.7% vs. 0.8% stroke (p=0.87), 9.2% vs. 11.8% major bleeding (p=0.31), 14.1% vs. 16.5% acute kidney injury (p=0.52), 62.0% vs. 64.6% home discharge (p=0.58), and 13.3% vs. 12.0% discharge to nursing home (p=0.58) among cancer vs. non-cancer patients, respectively. On the other hand, SMVP was associated with 3.1% vs. 3.5% in-hospital mortality (p=0.35), 2.6% vs. 3.1% stroke (p=0.16), 35.0% vs. 30.5% major bleeding (p<0.0001), 19.5% vs. 19.6% acute kidney injury (p=0.88), 32.8% vs. 38.6% home discharge (p<0.0001), 37.2% vs. 35.0% home health care use (p<0.0001), and 26.8 vs. 22.8% discharge to nursing home (p=0.05), among cancer vs. non-cancer patients respectively.
TMVR percent in mitral valve procedures

Conclusion
TMVR utilization for MR in cancer has steadily increased in both cancer and non-cancer patients, although it is proportionately higher among cancer patients in recent years. Overall, TMVR was associated with low in-hospital mortality and a similar safety profile in cancer and non-cancer patients, while SMVP appears to have a slightly worse safety profile in cancer patients. Our findings, suggest that TMVR is a reasonable strategy in selective cancer patients with MR.