Original article
Adult cardiac
Trends in Mitral Valve Surgery in the United States: Results From The Society of Thoracic Surgeons Adult Cardiac Database

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008
https://doi.org/10.1016/j.athoracsur.2009.01.064Get rights and content

Background

The purpose of this study is to examine trends in mitral valve (MV) repair and replacement surgery using The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD).

Methods

The study population included isolated mitral valve operations performed between January 2000 and December 2007 at 910 hospitals participating in the STS ACSD. Patients with endocarditis, prior cardiac operation, shock, emergency operation, and concomitant coronary artery bypass graft or aortic valve surgery were excluded.

Results

During the 8-year study period, 58,370 patients underwent isolated primary MV operations. For patients with isolated mitral regurgitation (n = 47,126), the rate of MV repair (versus replacement) increased from 51% to 69% (p < 0.0001). Among patients having replacement (n = 24,404), there has been a pronounced decline in the use of mechanical valves: 68% to 37% (p < 0.0001). The operative mortality for MV replacement was consistently higher than that for repair (3.8% versus 1.4%), a finding that persisted after risk-adjustment (adjusted odds ratio 0.52, 95% confidence interval: 0.45 to 0.59; p < 0.0001). Among patients having elective isolated MV repair (n = 28,140), the operative mortality was 1.2%. For asymptomatic (class I) patients, operative mortality was 0.6%.

Conclusions

This study documents several important trends in MV surgery, including the progressive adoption of mitral valve repair and increasing use of bioprosthetic replacement valves. Operative risks of MV repair are significantly lower than those for MV replacement. Operative mortality for isolated elective mitral valve repair is 1% in contemporary clinical practice.

Section snippets

Material and Methods

The STS ACSD now includes data for more than 3 million unique cardiac surgical operations from a majority of centers in North America. Clinical sites enter data using uniform definitions (available at: http://www.sts.org/doc/8428) and certified software systems. All data storage and analysis is performed at the Duke Clinical Research Institute.

Patient Population

Between January 2000 and December 2007, 210,529 mitral valve operations were identified in the STS ACSD at 910 centers. From this total, 127,261 patients (60%) were excluded owing to concomitant procedures (eg, concomitant bypass surgery), as were those with infective endocarditis, reoperation, those undergoing cardiopulmonary resuscitation or in cardiogenic shock, and those having pulmonary procedures and missing sex identification. Thus, our final study population consisted of a total of

Comment

This study evaluated outcomes for nearly 60,000 isolated mitral valve operations over an 8-year period. It provides a comprehensive assessment of the contemporary practice of mitral valve surgery and identifies a number of important trends, as well as areas for process and quality improvement. Between 2000 and 2007, the global rate of mitral valve repair increased from 42% to 61%, a 46% increase. This represents a significant increase above the 38% mitral repair rate reported in 1999 to 2000 [9

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Copyright © 2009 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.