Patient Risk-Benefit Preferences for Transcatheter Versus Surgical Mitral Valve Repair.
J Am Heart Assoc
; 13(6): e032807, 2024 Mar 19.
Article
em En
| MEDLINE
| ID: mdl-38471830
ABSTRACT
BACKGROUND:
Transcatheter edge-to-edge repair (TEER) of mitral regurgitation is less invasive than surgery but has greater 5-year mortality and reintervention risks, and leads to smaller improvements in physical functioning. The study objective was to quantify patient preferences for risk-benefit trade-offs associated with TEER and surgery. METHODS ANDRESULTS:
A discrete choice experiment survey was administered to patients with mitral regurgitation. Attributes included procedure type; 30-day mortality risk; 5-year mortality risk and physical functioning for 5 years; number of hospitalizations in the next 5 years; and risk of additional surgery in the next 5 years. A mixed-logit regression model was fit to estimate preference weights. Two hundred one individuals completed the survey 63% were female and mean age was 74 years. On average, respondents preferred TEER over surgery. To undergo a less invasive procedure (ie, TEER), respondents would accept up to a 13.3% (95% CI, 8.7%-18.5%) increase in reintervention risk above a baseline of 10%, 4.6 (95% CI, 3.1-6.2) more hospitalizations above a baseline of 1, a 10.7% (95% CI, 6.5%-14.5%) increase in 5-year mortality risk above a baseline of 20%, or more limited physical functioning representing nearly 1 New York Heart Association class (0.7 [95% CI, 0.4-1.1]) over 5 years.CONCLUSIONS:
Patients in general preferred TEER over surgery. When holding constant all other factors, a functional improvement from New York Heart Association class III to class I maintained over 5 years would be needed, on average, for patients to prefer surgery over TEER.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Implante de Prótese de Valva Cardíaca
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Procedimentos Cirúrgicos Cardíacos
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Insuficiência da Valva Mitral
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article