OBJECTIVES:

To estimate 30-day cardiovascular in-hospital mortality (CIHM) in patients who underwent heart valve surgery versus transcatheter therapy, using the Hospital Information System (HIS) of Italy.

METHODS:

From HIS, which collects information related to all discharges from public and private hospitals in Italy, we identified all patients aged ≥18 years undergoing single heart valve intervention (aortic/AV-population or mitral/MV-population) between January 2017 and November 2018.

For patients with multiple hospital admissions, only the first one was considered (index-event).

According to the type of intervention, subjects were classified into two groups: traditional surgery (TS) and transcatheter approach (TA).

30-day CIHM was evaluated considering index and subsequent hospitalizations with main diagnosis of circulatory system diseases.

Patient clinical history was defined by retrieving comorbidities recorded during hospitalizations

in the 2 years before the index-event.

The association between intervention and outcome was assessed using logistic models [Odds Ratio (OR)] and adjusting for age, sex and the risk factors selected by a stepwise bootstrap procedure.

RESULTS:

37,687 subjects were selected for AV-population (58.2% men, mean age 72.6 years): 29,004 (77.0%) undergoing TS and 8,683 (23.0%) TA.

30-day CIHM was 3.3% for TS patients and 2.2% for TA patients, (OR 0.64; 95%CI 0.55-0.75). Multivariate analysis confirmed a reduction of mortality for patients undergoing TA (OR_adj 0.52; 95%CI 0.43-0.61).

For MV-population, 15,340 patients were identified (60.0% men, mean age 65.5 years), of whom 13,711 (89.4%) undergoing TS surgery and 1,629 (10.6%) TA.

A reduction of 30-day CIHM for TA patients (2.3% vs 3.3%) was confirmed in both the univariate (OR 0.71; 95%CI 0.50-0.98) and multivariate model (OR_adj 0.50; 95%CI 0.35‑0.70).

CONCLUSIONS:

The study, based on Italian administrative databases, allowed to estimate the in-hospital mortality for patients with aortic and mitral heart valve disorders, highlighting a significant association between outcome and treatment strategy.