Mitral valve repair versus replacement for patients with preserved left ventricular function without heart failure symptoms

The Journal of Thoracic and Cardiovascular Surgery

Jeffrey P. Gold¹  Thoralf M. Sundt²  Leonard Girardi³  Desmond Jordan⁴  Zaza Samadashvili⁵  Craig R. Smith⁶  Edward L. Hannan⁷  Stephen J. Lahey⁸ 

[1] Cardiac Surgical Division, Massachusetts General Hospital, Boston, Mass;Department of Cardiothoracic Surgery, Kaleida Health, Buffalo, NY;Department of Cardiothoracic Surgery, Stony Brook School of Medicine, Stony Brook, NY and Department of Cardiothoracic Surgery, Mount Sinai Hospital, New York, NY;Department of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, NY;Department of Surgery, Columbia-Presbyterian Medical Center, New York, NY;Division of Cardiothoracic Surgery, University of Connecticut, Storrs, Conn;School of Public Health, University at Albany, State University of New York, Albany, NY;University of Nebraska Medical Center, Omaha, Neb

关键词: mitral valve repair;    mitral valve replacement;    mitral valve mortality;    propensity matching;    mitral valve readmissions;    mitral valve reoperations;   

DOI  :  10.1016/j.jtcvs.2018.08.091

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveThe purposes of this study are to compare outcomes of mitral valve repair (MV-repair) and mitral valve replacement for patients with severe mitral regurgitation with preserved ventricular function and no congestive heart failure (CHF) symptoms and to examine variations in surgeon choice of procedure and outcomes by surgeon volume.MethodsIn total, 2259 consecutive patients in 42 New York State hospitals with the characteristics mentioned previously who underwent mitral valve repair (1801, 79.7%) or replacement between January 1, 2008, and December 31, 2014, were identified from a mandatory statewide clinical registry. Propensity-matching was used to compare mortality and competing risk analyses were used to compare nonfatal outcomes. Median follow-up was 4.0 years. The use of mitral repair and risk-adjusted mortality for surgery were also examined as a function of individual surgeon mitral case volume.ResultsPropensity-matched patients who underwent MV-repair experienced a significantly lower mortality rate at 4 years (3.5% vs 12.1%, P ConclusionsPatients with chronic severe primary mitral valve regurgitation with preserved ventricular function and no CHF symptoms who underwent MV-repair experienced lower mortality and no different reoperation, CHF, or stroke readmission rates than patients who underwent replacement. Greater-volume surgeons were more likely than their lower volume counterparts to choose mitral repair. Repair should be considered as the surgical option for these patients whenever possible.

【 授权许可】

Unknown