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

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 157; no. 4; pp. 1432 - 1439.e2
• Main Authors: Hannan, Edward L., Samadashvili, Zaza, Smith, Craig R., Lahey, Stephen J., Gold, Jeffrey P., Jordan, Desmond, Sundt, Thoralf M., Girardi, Leonard, Ashraf, Mohammed H., Chikwe, Joanna
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2019
• Subjects: Aged; Clinical Decision-Making; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; Male; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Annuloplasty - adverse effects; Mitral Valve Annuloplasty - mortality; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - mortality; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; mitral valve mortality; mitral valve readmissions; mitral valve reoperations; mitral valve repair; mitral valve replacement; New York; Practice Patterns, Physicians; propensity matching; Recovery of Function; Registries; Risk Assessment; Risk Factors; Stroke Volume; Surgeons; Time Factors; Treatment Outcome; Ventricular Function, Left; Workload; New York; CHF; CIF; MR; mitral valve repair; mitral valve mortality; MVR; mitral valve readmissions; mitral valve reoperations; AHR; CSRS; MV-repair; SPARCS; ACC/AHA; CABG; mitral valve replacement; LVF; propensity matching
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2018.08.091

The 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. In 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. Propensity-matched patients who underwent MV-repair experienced a significantly lower mortality rate at 4 years (3.5% vs 12.1%, P < .001). Greater-volume surgeons were more likely to perform MV-repairs (92% vs 84%, 74%, and 69% in lower volume quartiles, respectively). No significant differences in mortality were observed among volume quartiles. Patients 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.