Mitral Valve Repair Surgery Shows Low Mortality

NEW YORK - Mitral valve repair surgery was associated with very low operative mortality and acceptable morbidity in a database analysis of 903 patients at 16 centers in Virginia presented at the 2011 Mitral Conclave.

Mitral valve repair (MVR) rather than replacement has become the favored surgical approach for mitral insufficiency over the last 2 decades. The recent emergence of transcatheter approaches to repair has focused attention on the outcomes for surgical approaches. In the EVEREST II trial, published earlier this year, worse short-term outcomes were seen with surgical MVR or replacement, compared with percutaneous MVR using the MitraClip device. Among 279 patients, composite major event rates at 30 days were 15% for percutaneous repair, compared with 48% for surgery (N. Engl. J. Med. 2011;364:1395-406).

The current study was undertaken to analyze contemporary outcomes for surgical mitral repair within a multiinstitutional cohort of patients to better establish a benchmark for future comparisons of treatments for mitral valve insufficiency, Dr. Damien J. LaPar said.

Cardiac surgical data were obtained from the 16 participating centers of the Virginia Cardiac Surgery Quality Initiative, which captures approximately 99% of the state?s cardiac operations. Patient exclusions were the same as in the EVEREST II trial: prior valve operations, endocarditis, and mitral stenosis.

The 903 patients had an average age of 57 years; 41% were women. Heart failure was present in 32%, and severe mitral insufficiency in 82%. Most (85%) of the operations were elective, including reconstruction with annuloplasty in 69%, said Dr. LaPar of the University of Virginia, Charlottesville.

Major adverse events occurred in 29%, a lower percentage than reported in EVEREST II. Atrial fibrillation was the most frequent, in 18%. Renal failure occurred in just 1.3%, stroke in 0.9%, and operative mortality in 1.1%. The mean postoperative length of stay was 6 days.

Multivariate predictors of major adverse events included age, preoperative stroke and immunosuppressive therapy, use of an aortic cross-clamp, and cardiopulmonary bypass times. Factors not significantly associated with major adverse events were female sex, renal failure, prior coronary artery bypass grafting, and ejection fraction.

 "These results may help stratify which patients might be best served by emerging approaches to surgery," he said.

This study was funded by a training grant from the National Heart, Lung, and Blood Institute and a research grant from the Thoracic Surgery Foundation for Research and Education. Dr. LaPar stated that he had no disclosures; three of his coinvestigators consult for, and/or received honoraria from Abbott, maker of the MitraClip device used in the study.

NEW YORK - Mitral valve repair surgery was associated with very low operative mortality and acceptable morbidity in a database analysis of 903 patients at 16 centers in Virginia presented at the 2011 Mitral Conclave.

Mitral valve repair (MVR) rather than replacement has become the favored surgical approach for mitral insufficiency over the last 2 decades. The recent emergence of transcatheter approaches to repair has focused attention on the outcomes for surgical approaches. In the EVEREST II trial, published earlier this year, worse short-term outcomes were seen with surgical MVR or replacement, compared with percutaneous MVR using the MitraClip device. Among 279 patients, composite major event rates at 30 days were 15% for percutaneous repair, compared with 48% for surgery (N. Engl. J. Med. 2011;364:1395-406).

The current study was undertaken to analyze contemporary outcomes for surgical mitral repair within a multiinstitutional cohort of patients to better establish a benchmark for future comparisons of treatments for mitral valve insufficiency, Dr. Damien J. LaPar said.

Cardiac surgical data were obtained from the 16 participating centers of the Virginia Cardiac Surgery Quality Initiative, which captures approximately 99% of the state?s cardiac operations. Patient exclusions were the same as in the EVEREST II trial: prior valve operations, endocarditis, and mitral stenosis.

The 903 patients had an average age of 57 years; 41% were women. Heart failure was present in 32%, and severe mitral insufficiency in 82%. Most (85%) of the operations were elective, including reconstruction with annuloplasty in 69%, said Dr. LaPar of the University of Virginia, Charlottesville.

Major adverse events occurred in 29%, a lower percentage than reported in EVEREST II. Atrial fibrillation was the most frequent, in 18%. Renal failure occurred in just 1.3%, stroke in 0.9%, and operative mortality in 1.1%. The mean postoperative length of stay was 6 days.

Multivariate predictors of major adverse events included age, preoperative stroke and immunosuppressive therapy, use of an aortic cross-clamp, and cardiopulmonary bypass times. Factors not significantly associated with major adverse events were female sex, renal failure, prior coronary artery bypass grafting, and ejection fraction.

 "These results may help stratify which patients might be best served by emerging approaches to surgery," he said.

This study was funded by a training grant from the National Heart, Lung, and Blood Institute and a research grant from the Thoracic Surgery Foundation for Research and Education. Dr. LaPar stated that he had no disclosures; three of his coinvestigators consult for, and/or received honoraria from Abbott, maker of the MitraClip device used in the study.

NEW YORK - Mitral valve repair surgery was associated with very low operative mortality and acceptable morbidity in a database analysis of 903 patients at 16 centers in Virginia presented at the 2011 Mitral Conclave.

Mitral valve repair (MVR) rather than replacement has become the favored surgical approach for mitral insufficiency over the last 2 decades. The recent emergence of transcatheter approaches to repair has focused attention on the outcomes for surgical approaches. In the EVEREST II trial, published earlier this year, worse short-term outcomes were seen with surgical MVR or replacement, compared with percutaneous MVR using the MitraClip device. Among 279 patients, composite major event rates at 30 days were 15% for percutaneous repair, compared with 48% for surgery (N. Engl. J. Med. 2011;364:1395-406).

The current study was undertaken to analyze contemporary outcomes for surgical mitral repair within a multiinstitutional cohort of patients to better establish a benchmark for future comparisons of treatments for mitral valve insufficiency, Dr. Damien J. LaPar said.

Cardiac surgical data were obtained from the 16 participating centers of the Virginia Cardiac Surgery Quality Initiative, which captures approximately 99% of the state?s cardiac operations. Patient exclusions were the same as in the EVEREST II trial: prior valve operations, endocarditis, and mitral stenosis.

The 903 patients had an average age of 57 years; 41% were women. Heart failure was present in 32%, and severe mitral insufficiency in 82%. Most (85%) of the operations were elective, including reconstruction with annuloplasty in 69%, said Dr. LaPar of the University of Virginia, Charlottesville.

Major adverse events occurred in 29%, a lower percentage than reported in EVEREST II. Atrial fibrillation was the most frequent, in 18%. Renal failure occurred in just 1.3%, stroke in 0.9%, and operative mortality in 1.1%. The mean postoperative length of stay was 6 days.

Multivariate predictors of major adverse events included age, preoperative stroke and immunosuppressive therapy, use of an aortic cross-clamp, and cardiopulmonary bypass times. Factors not significantly associated with major adverse events were female sex, renal failure, prior coronary artery bypass grafting, and ejection fraction.

 "These results may help stratify which patients might be best served by emerging approaches to surgery," he said.

This study was funded by a training grant from the National Heart, Lung, and Blood Institute and a research grant from the Thoracic Surgery Foundation for Research and Education. Dr. LaPar stated that he had no disclosures; three of his coinvestigators consult for, and/or received honoraria from Abbott, maker of the MitraClip device used in the study.