title: Feasibility and predictors of early discharge after percutaneous edge-to-edge mitral valve repair.
abstract: Percutaneous edge-to-edge mitral valve repair (PMVR) recently emerged as an effective treatment modality for patients with severe mitral regurgitation (MR). Length of postprocedural hospital stay may represent a modifiable cost associated with percutaneous treatment. We looked at feasibility, predictors and safety of early discharge (ED), defined as hospital discharge within 72 hours, in patients undergoing PMVR.
  
  
  
  Consecutive patients treated with MitraClip from October 2008 to December 2015 were analysed. Primary outcomes of interest were cardiovascular and non-cardiovascular mortality, rehospitalisation for heart failure and major adverse events at 30 days and 90 days. A total of 269 patients were included. Of these, 115 patients were early discharged (ED group). Rates of ED increased from 25.9% for the biennium 2008-2009 to 59.1% in 2014-2015 (p<0.001 for trend). In a penalised logistic regression model, male gender (OR=2.13, 95% CI 1.17 to 3.95) and procedural year (OR=2.13, 95% CI 1.51 to 3.11) were associated with higher probability of ED. Conversely, atrial fibrillation (OR=0.48, 95% CI 0.27 to 0.85), any Mitral Valve Academic Research Consortium bleeding (OR=0.07, 95% CI 0.01 to 0.60), log-transformed N-terminal pro-brain natriuretic peptide levels (OR=0.79, 95% CI 0.63 to 0.99) and postimplant MR grade (OR=0.60, 95% CI 0.37 to 0.94) conferred a lower likelihood of ED. In propensity score-weighted analyses, overall survival, freedom from heart failure and major adverse events at 30 days and 90 days were not different in ED and non-ED groups (all weighted log-rank p value>0.05).
  
  
  
  In selected patients undergoing PMVR, ED may be feasible and safe.
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Buccheri
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Popolo Rubbio
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Scandura
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Di Salvo
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mangiafico
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Immé
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Caruso
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Scalia
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Condorelli
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Piera
authors.initials: P
authors.lastname: Capranzano
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Grasso
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D010351:Patient Discharge / Q000639:trends*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors