Mitral Valve Repair Rate at a Veterans Affairs Hospital Utilizing a Multidisciplinary Heart Team.
Semin Thorac Cardiovasc Surg. 2019 Mar 05;:
Authors: Jimenez E, Wu D, Omer S, Cornwell L, Nunez P, Rosengart TK, Coselli JS
OBJECTIVE: Between 2000 and 2008, the mitral valve (MV) repair rate in patients with severe mitral regurgitation (MR) at our low-volume Veterans Affairs hospital was 21%. After instituting a multidisciplinary valve team in 2009, we determined whether this rate increased and characterized the outcomes of patients with degenerative disease.
METHODS: We retrospectively reviewed data from 103 MV operations performed at our hospital between 1/2009 and 8/2016. Mitral valve pathology was categorized as degenerative, rheumatic, endocarditis, ischemic, hypertrophic cardiomyopathy, or failed prior MV repair. The surgical techniques used for MV repair were reviewed. For the patients with degenerative disease who underwent MV repair, we assessed leaflet involvement and postoperative valve function.
RESULTS: For the full cohort, the MV repair rate was 67% and the 30-day mortality rate was 0.97%. Of the 74 patients with degenerative disease, 64 (86.5%) underwent MV repair (none required re-operation). For these patients, the MV repair rate was significantly higher when the surgical approach was sternotomy rather than minimally invasive right minithoracotomy (92.5% vs 71.4%, P=0.03). After MV repair, 95.3% of the degenerative disease patients had mild or less MR; median echocardiography follow-up time was 555 days. Anatomic features associated with a reduced MV repair rate in patients with degenerative disease were dystrophic leaflet calcification and severe mitral annular calcification.
CONCLUSIONS: In an institution with a low volume of MV operations, preoperative surgical planning with a multidisciplinary valve team was associated with improved MV repair rates and excellent repair quality in patients with degenerative valve disease.
PMID: 30849464 [PubMed - as supplied by publisher]