Anelechi C Anyanwu1, Shinobu Itagaki2, Joanna Chikwe2, Ahmed El-Eshmawi2, David H Adams2. 1. Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: anelechi.anyanwu@mountsinai.org. 2. Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Abstract
OBJECTIVE: To develop a score to allow stratification of complexity in degenerative mitral valve repair. METHODS: Retrospective modeling of data from 668 consecutive patients who underwent surgery for mitral valve prolapse. A complexity scoring scale was developed using a consensus approach, assigning a score to each valve, based on the following: prolapsing segments (weight 1 for each posterior segment; weight 2 for each anterior or commissural segment); presence of valve restriction (weight 2); presence of calcification (weight 3 if annulus involved, otherwise weight 2); and prior mitral valve repair (weight 3). Valve repairs were categorized into 3 groups based on the complexity score: 1: Simple (n = 244); 2-4: Intermediate (n = 260); ≥5: Complex (n = 164). RESULTS: Mitral valve repair was successfully performed in 667 patients (repair rate: 99.9%). The complexity score was directly correlated with surrogates of technical complexity. The mean cardiopulmonary bypass time increased with lesion complexity ([in minutes] simple: 152; intermediate: 167; complex 195; P < .001). The median number of repair techniques utilized was related to lesion complexity (simple: 3; intermediate: 4; complex: 5; P < .001). Barlow's type etiology was more prevalent in complex cases (63%), compared with simple (9%) and intermediate (35%) cases (P < .001). Advanced repair techniques were required to complete repair in 51% of complex cases, compared with 14% of intermediate and 0% of simple cases (P < .001). Early and late outcomes were similar. CONCLUSIONS: Our scoring system may allow effective stratification of complexity of mitral valve repair. Future studies are required to evaluate the use of our score in a prospective setting.
OBJECTIVE: To develop a score to allow stratification of complexity in degenerative mitral valve repair. METHODS: Retrospective modeling of data from 668 consecutive patients who underwent surgery for mitral valve prolapse. A complexity scoring scale was developed using a consensus approach, assigning a score to each valve, based on the following: prolapsing segments (weight 1 for each posterior segment; weight 2 for each anterior or commissural segment); presence of valve restriction (weight 2); presence of calcification (weight 3 if annulus involved, otherwise weight 2); and prior mitral valve repair (weight 3). Valve repairs were categorized into 3 groups based on the complexity score: 1: Simple (n = 244); 2-4: Intermediate (n = 260); ≥5: Complex (n = 164). RESULTS:Mitral valve repair was successfully performed in 667 patients (repair rate: 99.9%). The complexity score was directly correlated with surrogates of technical complexity. The mean cardiopulmonary bypass time increased with lesion complexity ([in minutes] simple: 152; intermediate: 167; complex 195; P < .001). The median number of repair techniques utilized was related to lesion complexity (simple: 3; intermediate: 4; complex: 5; P < .001). Barlow's type etiology was more prevalent in complex cases (63%), compared with simple (9%) and intermediate (35%) cases (P < .001). Advanced repair techniques were required to complete repair in 51% of complex cases, compared with 14% of intermediate and 0% of simple cases (P < .001). Early and late outcomes were similar. CONCLUSIONS: Our scoring system may allow effective stratification of complexity of mitral valve repair. Future studies are required to evaluate the use of our score in a prospective setting.
Authors: Alexandr V Bogachev-Prokophiev; Alexandr V Afanasyev; Sergei I Zheleznev; Vladimir M Nazarov; Ravil M Sharifulin; Alexandr M Karaskov Journal: J Cardiothorac Surg Date: 2017-12-13 Impact factor: 1.637
Authors: Maria Concetta Pastore; Giulia Elena Mandoli; Anna Sannino; Aleksander Dokollari; Gianluigi Bisleri; Flavio D'Ascenzi; Luna Cavigli; Annalisa Pasquini; Matteo Lisi; Nicolò Ghionzoli; Ciro Santoro; Marcelo Haertel Miglioranza; Marta Focardi; Giuseppe Patti; Serafina Valente; Sergio Mondillo; Matteo Cameli Journal: Front Cardiovasc Med Date: 2021-07-08