Mitral valve surgery in the US Veterans Administration health system: 10-year outcomes and trends

The Journal of Thoracic and Cardiovascular Surgery

Marco A. Zenati¹  Faisal G. Bakaeen²  Rakesh M. Suri³  Vinod H. Thourani⁴  Vinay Badhwar⁵  Mary T. Hawn⁶  Shuab Omer⁷  Danny Chu⁸  A. Marc Gillinov⁹  Joseph F. Sabik^1,10  James S. Gammie^1,11  A. Laurie Shroyer^1,12 

[1] Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex;Department of Surgery, Baylor College of Medicine, Houston, Tex;Department of Surgery, Brigham and Women's Hospital, Boston, Mass;Department of Surgery, Stony Brook Medicine, Stony Brook, NY;Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio;Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa;Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md;Division of Cardiothoracic Surgery, Emory University, Atlanta, Ga;Division of Cardiothoracic Surgery, West Virginia University, Morgantown, WVa;Harvard Medical School, Boston, Mass;Research and Development Office, Northport VA Medical Center, Northport, NY;The Michael E. DeBakey VA Medical Center, Houston, Tex

关键词: mitral valve;    mitral valve repair;    mitral valve replacement;    volume;    outcomes;    trends;   

DOI  :  10.1016/j.jtcvs.2017.07.089

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveTo compare mitral valve repair (MVRepair) and mitral valve replacement (MVReplace) trends in the Veterans Affairs (VA) Surgical Quality Improvement Program.MethodsTrends 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.ResultsFrom 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 2 = 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).ConclusionsIn 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.

【 授权许可】

Unknown