Abstract Body (Do not enter title and authors here): Background:
Dementia is a prevalent comorbidity in patients undergoing the transcatheter edge-to-edge repair (TEER) procedure of the mitral valve. This study compares outcomes of mitral valve TEER in patients with and without dementia, utilizing data from the National Inpatient Sample (2016-2021)
Methods:
We conducted a retrospective cohort study on 48,085 patients without dementia and 3,125 with dementia undergoing mitral valve TEER. Multivariate logistic regression was employed to compare outcomes, adjusting for potential confounders. Primary outcomes included mortality and major complications, while secondary outcomes encompassed specific procedural complications.
Results:
Patients with dementia were older (mean age: 80.896 vs. 76.69 years, p-value <0.001) and exhibited differences in gender distribution (male: 49.92% vs. 54.24%, female: 50.08% vs. 45.76%, p=0.0356).Patients with dementia had a longer LOS (coefficient: 1.64 days, 95% CI: 0.85-2.43, p<0.001) and higher total hospitalisation cost (coefficient: $19,868.97, 95% CI: $302.45-$39,435.49, p=0.047). Patients with dementia exhibited a higher prevalence of mortality (OR: 1.677, 95% CI: 1.049-2.68, p=0.031), bleeding (OR: 1.4807, 95% CI: 1.156-1.896, p=0.002), PPM insertion (OR: 3.351, 95% CI: 1.463-7.674, p=0.004), post-procedure shock (OR: 2.027, 95% CI: 1.478-2.779, p<0.001), intra-procedure stroke (OR: 1.971, 95% CI: 1.438-2.701, p<0.001), mechanical ventilation (OR: 3.088, 95% CI: 2.172-4.389, p<0.001), and cardiogenic shock (OR: 1.949, 95% CI: 1.418-2.678, p<0.001). Additionally, they had increased odds of sepsis (OR: 1.974, 95% CI: 1.125-3.466, p=0.018) and stroke (OR: 1.987, 95% CI: 1.007-3.923, p=0.048), as well as a higher likelihood of pleural effusion (OR: 2.167, 95% CI: 1.501-3.128, p<0.001). Odds of arrhythmia and post-procedure deep vein thrombosis did not significantly differ between groups.
Conclusion:
Patients with dementia undergoing mitral valve TEER procedure face elevated risks of mortality, bleeding, PPM insertion, post-operative shock, stroke, and other major complications compared to those without dementia. Clinicians should consider these heightened risks when evaluating the appropriateness of mitral valve TEER in dementia patients. Further research is warranted to explore strategies for risk mitigation in this population.