Faisal G Bakaeen1, A Laurie Shroyer2, Marco A Zenati3, Vinay Badhwar4, Vinod H Thourani5, James S Gammie6, Rakesh M Suri7, Joseph F Sabik7, A Marc Gillinov7, Danny Chu8, Shuab Omer9, Mary T Hawn10, G Hossein Almassi11, Lorraine D Cornwell9, Frederick L Grover12, Todd K Rosengart13, Laura Graham14. 1. Department of Surgery, Baylor College of Medicine, Houston, Tex; The Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: Bakaeef@ccf.org. 2. Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Research and Development Office, Northport VA Medical Center, Northport, NY. 3. Department of Surgery, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. 4. Division of Cardiothoracic Surgery, West Virginia University, Morgantown, WVa. 5. Division of Cardiothoracic Surgery, Emory University, Atlanta, Ga. 6. Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md. 7. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. 8. Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa. 9. Department of Surgery, Baylor College of Medicine, Houston, Tex; The Michael E. DeBakey VA Medical Center, Houston, Tex. 10. Department of Surgery, Stanford University, Palo Alto, Calif. 11. Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wis; Zablocki VA Medical Center, Milwaukee, Wis. 12. Department of Surgery, University of Colorado Denver, Aurora, Colo; Denver VA Medical Center, Aurora, Colo. 13. Department of Surgery, Baylor College of Medicine, Houston, Tex; The Michael E. DeBakey VA Medical Center, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex. 14. The Birmingham and Tuscaloosa Health Services Research & Development Program, Birmingham VA Medical Center, Birmingham, Ala; Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala.
Abstract
OBJECTIVE: To compare mitral valve repair (MVRepair) and mitral valve replacement (MVReplace) trends in the Veterans Affairs (VA) Surgical Quality Improvement Program. METHODS: Trends were compared by bivariate analyses, followed by backward stepwise selection and multivariable logistic modeling to determine the effect of preoperative comorbidities and facility-level factors on MVRepair (vs MVReplace) rate. A subgroup analysis focused on patients who underwent elective surgery for isolated primary degenerative mitral regurgitation. Propensity matching was done in the overall and primary degenerative cohorts. RESULTS: From October 2000 to October 2013, 4165 veterans underwent MVRepair (n = 2408) or MVReplace (n = 1757) for MV disease of any cause at 40 VA medical centers (procedural volume, 0-29/y; median 7/y). The MVRepair percentage increased from 48% in 2001 to 63% in 2013 (P < .001). MVRepair rates varied widely among centers; center volume explained only 19% of this variation after adjustment for case mix (R2 = 0.19, P = .005). Unadjusted 30-day and 1-year mortality rates were lower after MVRepair than after MVReplace (3.5% vs 4.8%, P = .04; 9.8% vs 12.1%, P = .02). Among the propensity-matched patients (n = 2520), 30-day and 1-year mortality were similar after MVRepair and MVReplace. In the propensity-matched primary degenerative subgroup (n = 664), unadjusted long-term mortality for up to 10 years postoperatively was lower after MVRepair (28% vs 37%, P = .003), as was risk-adjusted long-term mortality (hazard ratio, 0.78; 95% confidence interval, 0.61-1.01). CONCLUSIONS: In the VA Health System, mortality after MV operations is low. Despite the survival advantage associated with MV repair in primary mitral regurgitation, repair is infrequent at some centers, representing an opportunity for quality improvement.
OBJECTIVE: To compare mitral valve repair (MVRepair) and mitral valve replacement (MVReplace) trends in the Veterans Affairs (VA) Surgical Quality Improvement Program. METHODS: Trends were compared by bivariate analyses, followed by backward stepwise selection and multivariable logistic modeling to determine the effect of preoperative comorbidities and facility-level factors on MVRepair (vs MVReplace) rate. A subgroup analysis focused on patients who underwent elective surgery for isolated primary degenerative mitral regurgitation. Propensity matching was done in the overall and primary degenerative cohorts. RESULTS: From October 2000 to October 2013, 4165 veterans underwent MVRepair (n = 2408) or MVReplace (n = 1757) for MV disease of any cause at 40 VA medical centers (procedural volume, 0-29/y; median 7/y). The MVRepair percentage increased from 48% in 2001 to 63% in 2013 (P < .001). MVRepair rates varied widely among centers; center volume explained only 19% of this variation after adjustment for case mix (R2 = 0.19, P = .005). Unadjusted 30-day and 1-year mortality rates were lower after MVRepair than after MVReplace (3.5% vs 4.8%, P = .04; 9.8% vs 12.1%, P = .02). Among the propensity-matched patients (n = 2520), 30-day and 1-year mortality were similar after MVRepair and MVReplace. In the propensity-matched primary degenerative subgroup (n = 664), unadjusted long-term mortality for up to 10 years postoperatively was lower after MVRepair (28% vs 37%, P = .003), as was risk-adjusted long-term mortality (hazard ratio, 0.78; 95% confidence interval, 0.61-1.01). CONCLUSIONS: In the VA Health System, mortality after MV operations is low. Despite the survival advantage associated with MV repair in primary mitral regurgitation, repair is infrequent at some centers, representing an opportunity for quality improvement.
Authors: Ana López-de-Andrés; Javier de Miguel-Díez; Nuria Muñoz-Rivas; Valentín Hernández-Barrera; Manuel Méndez-Bailón; José M de Miguel-Yanes; Rodrigo Jiménez-García Journal: Cardiovasc Diabetol Date: 2019-05-10 Impact factor: 9.951
Authors: Michael J Paulsen; Mateo Marin Cuartas; Annabel Imbrie-Moore; Hanjay Wang; Robert Wilkerson; Justin Farry; Yuanjia Zhu; Michael Ma; John W MacArthur; Y Joseph Woo Journal: JTCVS Tech Date: 2021-10-07
Authors: Jordan E Morningstar; Annah Nieman; Christina Wang; Tyler Beck; Andrew Harvey; Russell A Norris Journal: J Am Heart Assoc Date: 2021-06-22 Impact factor: 5.501