Risk of Surgical Mitral Valve Repair for Primary Mitral Regurgitation

被引:43
作者
Badhwar, Vinay [1 ,11 ]
Chikwe, Joanna [2 ]
Gillinov, A. Marc [3 ]
Vemulapalli, Sreek [4 ]
O'Gara, Patrick T. [5 ]
Mehaffey, J. Hunter [1 ]
Ballmoos, Moritz Wyler von [6 ]
Bowdish, Michael E.
Gray, Elizabeth L. [7 ]
O'Brien, Sean M. [8 ]
Thourani, Vinod H. [9 ]
Shahian, David M. [10 ]
Habib, Robert H.
机构
[1] West Virginia Univ, Dept Cardiovasc & Thorac Surg, Morgantown, WV USA
[2] Smidt Heart Inst, Cedars Sinai Med Ctr, Dept Cardiac Surg, Los Angeles, CA USA
[3] Cleveland Clin, Dept Thorac & Cardiovasc Surg, Cleveland Hts, OH USA
[4] Duke Univ, Dept Med, Durham, NC USA
[5] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Boston, MA USA
[6] Univ Hosp Zurich, Dept Cardiac Surg, Zurich, Switzerland
[7] Soc Thorac Surg, STS Analyt & Res Ctr, Chicago, IL USA
[8] Duke Univ, Dept Biostat & Bioinformat, Durham, NC USA
[9] Piedmont Heart Inst, Dept Cardiac Surg, Atlanta, GA USA
[10] Harvard Med Sch, Massachusetts Gen Hosp, Dept Surg, Div Cardiac Surg, Boston, MA USA
[11] West Virginia Univ, Dept Cardiovasc & Thorac Surg, 1 Med Ctr Dr, Mor, Hungary
基金
美国国家卫生研究院;
关键词
SURGERY;
D O I
10.1016/j.athoracsur.2022.12.024
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Risk estimation for surgical intervention is an essential component of heart team shared decision -making. However, current mitral valve (MV) surgery risk models used in practice lack etiologic or procedural speci-ficity. The purpose of this study was to establish a comprehensive method for assessment of operative risk of MV repair of primary mitral regurgitation (MR). METHODS A novel etiology and procedure-specific algorithm identified 53,462 consecutive (July 2014 to June 2020) intention-to-treat MV repair patients with primary MR from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Risk models were fit for 30-day operative mortality, mortality and/or major morbidity, and conversion -to-replacement (CONV). As-treated mortality and morbidity models were derived separately. RESULTS Event rates for mortality (n = 619; 1.16%), mortality plus morbidity (n = 4746; 8.88%), and CONV (n = 3399; 6.36%) were low. Mortality was higher in CONV patients vs repair (3.18% vs 1.02%). All event rates were lower with increasing program volumes. The mortality risk model had excellent discrimination (AUC: 0.807) and calibration and confirmed very low mortality risk for isolated MV repair for primary MR, with mean mortality risk of 1.16% and median of 0.55% (interquartile range: 0.30%-1.17%) with 90th and 95th percentiles 2.48% and 3.99%, respectively. The mortality risk was <0.5% in patients <65 years of age, with 97% of the total population across age groups having a risk of <3%. Only 1 in 4 patients age 75 or older had >3% estimated risk of mortality. CONCLUSIONS This etiologic and procedure-specific risk model establishes that the contemporary mortality risk of MV repair for primary MR is <1% for the vast majority of patients. (Ann Thorac Surg 2023;115:600-10) (c) 2023 American College of Cardiology and The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved
引用
收藏
页码:600 / 610
页数:11
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