Abstract
BACKGROUND: Percutaneous aspiration thrombectomy is increasingly used as an alternative to surgery for right-sided heart masses, but nationwide data are limited.
METHODS: We analyzed Medicare fee-for-service beneficiaries aged ≥65 years who underwent percutaneous or surgical removal of right-sided heart masses from 2016 to 2021. We examined the temporal change in the number of percutaneous and surgical cases. The association between procedural types and patient characteristics was assessed using a multivariable logistic regression analysis. The primary outcomes were in-hospital and 2-year death. Given baseline differences between groups, we reported overall outcomes from the unadjusted cohort and comparative outcomes after adjustment using propensity score matching.
RESULTS: A total of 831 patients were included (447 percutaneous, 384 surgical), with the proportion of percutaneous cases increasing from 45.8% in 2016 to 65.0% in 2021. Patients with thrombosis (adjusted odds ratio, 3.42 [95% CI, 2.14-5.46]) and infective endocarditis (adjusted odds ratio, 10.08 [95% CI, 5.39-18.85]) were more often treated with percutaneous interventions. In-hospital and 2-year death in the percutaneous group were 11.0% and 43.0%, respectively. In the surgery group, those were 21.1% and 42.9%, respectively. Propensity score matching yielded 221 pairs. In the matched cohort, in-hospital death remained lower with the percutaneous group (10.4% versus 19.5%; P=0.01), while 2-year death was similar (hazard ratio, 1.00 [95% CI, 0.74-1.34]).
CONCLUSIONS: This study from a national database demonstrated that percutaneous intervention for right-sided heart masses has become the predominant strategy compared with surgery. Further trials are required to compare efficacy and safety between these interventions.