title: Balloon mitral valvuloplasty in the United States: a 13-year perspective.
abstract: BACKGROUND
  Incidence and prevalence of mitral stenosis is declining in the US. We performed this study to determine recent trends in utilization, complications, mortality, length of stay, and cost associated with balloon mitral valvuloplasty.
  
  
  METHODS
  Utilizing the nationwide inpatient sample database from 1998 to 2010, we identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure code for "percutaneous valvuloplasty." Patients ≥18 years of age with mitral stenosis were included. Patients with concomitant aortic, tricuspid, or pulmonic stenosis were excluded. Primary outcome included death and procedural complications.
  
  
  RESULTS
  A total of 1308 balloon mitral valvuloplasties (weighted n = 6540) were analyzed. There was a 7.5% decrease in utilization of the procedure from 24.6 procedures/10 million population in 1998-2001 to 22.7 procedures/10 million population in 2008-2010 (P for trend = .098). We observed a 15.9% overall procedural complication rate and 1.7% mortality rate. The procedural complication rates have increased in recent years (P = .001), corresponding to increasing age and burden of comorbidities in patients. The mean cost per admission for balloon mitral valvuloplasty has gone up significantly over the 10 years, from $11,668 ± 1046 in 2001 to $23,651 ± 301 in 2010 (P <.001).
  
  
  CONCLUSIONS
  In a large cross-sectional study of balloon mitral valvuloplasty in the US, we have reported trends of decreasing overall utilization and increasing procedural complication rates and cost over a period of 13 years.
authors.affiliation: Detroit Medical Center, Mich.
authors.forename: Apurva O
authors.initials: AO
authors.lastname: Badheka
authors.affiliation: Staten Island University Hospital, NY.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Shah
authors.affiliation: University of Miami Miller School of Medicine, Fla.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Ghatak
authors.affiliation: Staten Island University Hospital, NY.
authors.forename: Nileshkumar J
authors.initials: NJ
authors.lastname: Patel
authors.affiliation: MedStar Washington Hospital Center, Washington, DC.
authors.forename: Ankit
authors.initials: A
authors.lastname: Chothani
authors.affiliation: UPMC Shadyside Hospital, Pittsburgh, Pa.
authors.forename: Kathan
authors.initials: K
authors.lastname: Mehta
authors.affiliation: University of Miami Miller School of Medicine, Fla.
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Detroit Medical Center, Mich.
authors.forename: Nilay
authors.initials: N
authors.lastname: Patel
authors.affiliation: University of Miami Miller School of Medicine, Fla.
authors.forename: Peeyush
authors.initials: P
authors.lastname: Grover
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshmukh
authors.affiliation: Detroit Medical Center, Mich.
authors.forename: Sidakpal S
authors.initials: SS
authors.lastname: Panaich
authors.affiliation: University of Miami Miller School of Medicine, Fla.
authors.forename: Ghanshyambhai T
authors.initials: GT
authors.lastname: Savani
authors.affiliation: Detroit Medical Center, Mich.
authors.forename: Vipulkumar
authors.initials: V
authors.lastname: Bhalara
authors.affiliation: Detroit Medical Center, Mich.
authors.forename: Shilpkumar
authors.initials: S
authors.lastname: Arora
authors.affiliation: Cedars-Sinai Medical Centre, Los Angeles, Calif.
authors.forename: Ankit
authors.initials: A
authors.lastname: Rathod
authors.affiliation: University of Miami Miller School of Medicine, Fla.
authors.forename: Harit
authors.initials: H
authors.lastname: Desai
authors.affiliation: Cedars-Sinai Medical Centre, Los Angeles, Calif.
authors.forename: Saibal
authors.initials: S
authors.lastname: Kar
authors.affiliation: University of Miami Miller School of Medicine, Fla.
authors.forename: Carlos
authors.initials: C
authors.lastname: Alfonso
authors.affiliation: Massachusetts General Hospital, Boston.
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
authors.affiliation: Detroit Medical Center, Mich.
authors.forename: Cindy
authors.initials: C
authors.lastname: Grines
authors.affiliation: Detroit Medical Center, Mich.
authors.forename: Theodore
authors.initials: T
authors.lastname: Schreiber
authors.affiliation: Mayo Clinic, Rochester, Minn.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.affiliation: Cedars-Sinai Medical Centre, Los Angeles, Calif.
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
authors.affiliation: University of Miami Miller School of Medicine, Fla.
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
authors.affiliation: Henry Ford Hospital, Detroit, Mich.
authors.forename: William
authors.initials: W
authors.lastname: O'Neill
authors.affiliation: University of Miami Miller School of Medicine, Fla. Electronic address: emarchen@med.miami.edu.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Marchena
mesh_terms: D017677:Age Distribution; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D015897:Comorbidity; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000453:epidemiology / Q000628:therapy*; D044469:Racial Groups / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: Balloon; Complications; Cost; Hospital stay; Mitral valve; Mortality; Valvuloplasty