James S Gammie1, Joanna Chikwe2, Vinay Badhwar3, Dylan P Thibault4, Sreekanth Vemulapalli4, Vinod H Thourani5, Marc Gillinov6, David H Adams2, J Scott Rankin3, Mehrdad Ghoreishi7, Alice Wang4, Gorav Ailawadi8, Jeffrey P Jacobs9, Rakesh M Suri6, Steven F Bolling10, Nathaniel W Foster7, Rachael W Quinn7. 1. Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address: jsgammiemd@gmail.com. 2. Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York. 3. Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia. 4. Duke Clinical Research Institute, Durham, North Carolina. 5. Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia. 6. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. 7. Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland. 8. University of Virginia, Charlottesville, Virginia. 9. Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida. 10. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: Data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database were analyzed to identify trends in patient characteristics and outcomes of mitral valve operations in North America. METHODS: All patients with isolated primary mitral valve operations with or without tricuspid valve repair, surgical atrial fibrillation ablation, or atrial septal defect closure performed July 2011 to September 2016 were identified. A subgroup analysis assessed patients with degenerative leaflet prolapse (DLP). RESULTS: Isolated primary mitral valve operations were performed on 87,214 patients at 1,125 centers, increasing by 24% between 2011 (n = 14,442) and 2016 (n = 17,907). The most common etiology was DLP (60.7%); 4.3% had functional mitral regurgitation. Preoperatively, 47.3% of patients had an ejection fraction less than 60% and 34.2% had atrial fibrillation. Overall mitral valve repair rate was 65.6%, declining from 67.1% (2011) to 63.2% (2016; p < 0.0001). Repair rates were related to etiology (DLP, 82.5%; rheumatic, 17.5%). Of the 29,970 mitral valve replacements, 16.2% were preceded by an attempted repair. Repair techniques included prosthetic annuloplasty (94.3%), leaflet resection (46.5%), and artificial cord implantation (22.7%). Bioprosthetic valves were implanted with increasing frequency (2011, 65.4%; 2016, 75.8%; p < 0.0001). Less-invasive operations were performed in 23.0% and concomitant tricuspid valve repair in 15.7%. Unadjusted operative mortality was 3.7% (replacements) and 1.1% (repairs). CONCLUSIONS: Patients undergoing primary isolated mitral valve operations commonly have ventricular dysfunction, atrial fibrillation, and heart failure. Although contemporary outcomes are excellent, earlier guideline-directed referral and increased frequency and quality of repair may further improve results of mitral valve operations.
BACKGROUND: Data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database were analyzed to identify trends in patient characteristics and outcomes of mitral valve operations in North America. METHODS: All patients with isolated primary mitral valve operations with or without tricuspid valve repair, surgical atrial fibrillation ablation, or atrial septal defect closure performed July 2011 to September 2016 were identified. A subgroup analysis assessed patients with degenerative leaflet prolapse (DLP). RESULTS: Isolated primary mitral valve operations were performed on 87,214 patients at 1,125 centers, increasing by 24% between 2011 (n = 14,442) and 2016 (n = 17,907). The most common etiology was DLP (60.7%); 4.3% had functional mitral regurgitation. Preoperatively, 47.3% of patients had an ejection fraction less than 60% and 34.2% had atrial fibrillation. Overall mitral valve repair rate was 65.6%, declining from 67.1% (2011) to 63.2% (2016; p < 0.0001). Repair rates were related to etiology (DLP, 82.5%; rheumatic, 17.5%). Of the 29,970 mitral valve replacements, 16.2% were preceded by an attempted repair. Repair techniques included prosthetic annuloplasty (94.3%), leaflet resection (46.5%), and artificial cord implantation (22.7%). Bioprosthetic valves were implanted with increasing frequency (2011, 65.4%; 2016, 75.8%; p < 0.0001). Less-invasive operations were performed in 23.0% and concomitant tricuspid valve repair in 15.7%. Unadjusted operative mortality was 3.7% (replacements) and 1.1% (repairs). CONCLUSIONS:Patients undergoing primary isolated mitral valve operations commonly have ventricular dysfunction, atrial fibrillation, and heart failure. Although contemporary outcomes are excellent, earlier guideline-directed referral and increased frequency and quality of repair may further improve results of mitral valve operations.
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