Does Urgent or Emergent Status Influence Choice in Mitral Valve Operations? An Analysis of Outcomes from the Virginia Cardiac Surgery Quality Initiative

Overview

Journal Ann Thorac Surg

Publisher Elsevier

Specialties General Surgery
Pulmonary Medicine

Date 2010 Jul 9

PMID 20609766

Citations 4

Authors

Damien J LaPar

Sara Hennessy

Eddie Fonner

John A Kern

Irving L Kron

Gorav Ailawadi

Affiliations

Soon will be listed here.

Abstract

Background: Urgent or emergent status is often associated with increased risk among cardiac operations. The objective of this study was to analyze outcomes and cost differences in patients undergoing elective versus urgent or emergent mitral valve replacement (MVR) and repair operations.

Methods: From 2003 to 2008, 1,477 patients underwent isolated, primary mitral valve (MV) operations at 11 different centers in the Commonwealth of Virginia. Patients were stratified into four groups: elective MVR (n = 419), elective MV repair (n = 674), urgent or emergent MVR (n = 261) and urgent or emergent MV repair (n = 123). Preoperative risk, operative features, outcomes, and total costs were evaluated.

Results: Mitral valve replacement patients had more risk factors, including advanced age. Female sex and severe mitral regurgitation were more common among MV repairs. Mitral valve replacement incurred higher operative mortality (5.2% versus 1.2%; p < 0.001), more major complications (20.6% versus 6.5%; p < 0.001), longer postoperative (10.8 days versus 6.2 days; p < 0.001) and intensive care unit (117.7 hours versus 51.4 hours; p < 0.001) duration, and greater total costs ($45,166 versus $26,229; p < 0.001) compared with MV repair operations. Postoperative length of stay was longer for elective MVR patients compared with elective MV repair patients (p < 0.001) as well as for urgent or emergent MVR patients compared with urgent or emergent MV repair patients (p = 0.001). Total hospital costs were also higher for both elective MVR (p < 0.001) and urgent or emergent MVR (p < 0.001) compared with elective MV repair and urgent or emergent MV repair. Risk-adjusted operative mortality (odds ratio, 11.4; p < 0.001) and major complication rates (odds ratio, 7.6; p < 0.001) were highest for urgent or emergent MVR.

Conclusions: Mitral valve repair is associated with lower morbidity, mortality, and total costs compared with MVR. For urgent or emergent operations, the improved outcomes with mitral repair versus replacement are even more profound.

Citing Articles

Urgent Transcatheter Mitral Edge-to-Edge Repair Is Associated With Worse in-Hospital Outcomes: A Nationwide Analysis.

Diaz-Arocutipa C, Benites-Moya C, Torres-Valencia J, Mehta A, Vicent L Clin Cardiol. 2025; 48(3):e70067.

PMID: 40063420 PMC: 11892689. DOI: 10.1002/clc.70067.

Outcomes and quality of life in patients receiving mitral surgery for asymptomatic disease.

Iyengar A, Weingarten N, Rekhtman D, Song C, Shin M, Helmers M JTCVS Open. 2024; 18:43-51.

PMID: 38690429 PMC: 11056450. DOI: 10.1016/j.xjon.2024.01.015.

Economic Analysis and Long-term Follow-up of Distant Referral for Degenerative Mitral Valve Repair.

Brescia A, Paulsen M, Watt T, Rosenbloom L, Wisniewski A, Li J Ann Thorac Surg. 2020; 111(2):479-486.

PMID: 32693045 PMC: 7855358. DOI: 10.1016/j.athoracsur.2020.05.114.

Mitral valve repair versus replacement.

Mick S, Keshavamurthy S, Gillinov A Ann Cardiothorac Surg. 2015; 4(3):230-7.

PMID: 26309824 PMC: 4533076. DOI: 10.3978/j.issn.2225-319X.2015.03.01.

Long-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review.

McNeely C, Vassileva C Curr Cardiol Rev. 2014; 11(2):157-62.

PMID: 25158683 PMC: 4356723. DOI: 10.2174/1573403x10666140827093650.

References

Grossi E, Goldberg J, Lapietra A, Ye X, Zakow P, Sussman M . Ischemic mitral valve reconstruction and replacement: comparison of long-term survival and complications. J Thorac Cardiovasc Surg. 2001; 122(6):1107-24. DOI: 10.1067/mtc.2001.116945. View

Lee E, Shapiro L, Wells F . Importance of subvalvular preservation and early operation in mitral valve surgery. Circulation. 1996; 94(9):2117-23. DOI: 10.1161/01.cir.94.9.2117. View

Thourani V, Weintraub W, Guyton R, Jones E, Williams W, Elkabbani S . Outcomes and long-term survival for patients undergoing mitral valve repair versus replacement: effect of age and concomitant coronary artery bypass grafting. Circulation. 2003; 108(3):298-304. DOI: 10.1161/01.CIR.0000079169.15862.13. View

David T, Uden D, STRAUSS H . The importance of the mitral apparatus in left ventricular function after correction of mitral regurgitation. Circulation. 1983; 68(3 Pt 2):II76-82. View

Detaint D, Sundt T, Nkomo V, Scott C, Tajik A, Schaff H . Surgical correction of mitral regurgitation in the elderly: outcomes and recent improvements. Circulation. 2006; 114(4):265-72. DOI: 10.1161/CIRCULATIONAHA.106.619239. View

Seeburger J, Borger M, Falk V, Kuntze T, Czesla M, Walther T . Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. Eur J Cardiothorac Surg. 2008; 34(4):760-5. DOI: 10.1016/j.ejcts.2008.05.015. View

DiBardino D, ElBardissi A, McClure R, Razo-Vasquez O, Kelly N, Cohn L . Four decades of experience with mitral valve repair: analysis of differential indications, technical evolution, and long-term outcome. J Thorac Cardiovasc Surg. 2009; 139(1):76-83. DOI: 10.1016/j.jtcvs.2009.08.058. View

Ailawadi G, Swenson B, Girotti M, Gazoni L, Peeler B, Kern J . Is mitral valve repair superior to replacement in elderly patients?. Ann Thorac Surg. 2008; 86(1):77-85. DOI: 10.1016/j.athoracsur.2008.03.020. View

Braunberger E, Deloche A, Berrebi A, Abdallah F, Celestin J, Meimoun P . Very long-term results (more than 20 years) of valve repair with carpentier's techniques in nonrheumatic mitral valve insufficiency. Circulation. 2001; 104(12 Suppl 1):I8-11. View

10.

Gammie J, Sheng S, Griffith B, Peterson E, Rankin J, OBrien S . Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2009; 87(5):1431-7. DOI: 10.1016/j.athoracsur.2009.01.064. View

11.

Gillinov A, Wierup P, Blackstone E, Bishay E, Cosgrove D, White J . Is repair preferable to replacement for ischemic mitral regurgitation?. J Thorac Cardiovasc Surg. 2001; 122(6):1125-41. DOI: 10.1067/mtc.2001.116557. View

12.

Christakis G, Weisel R, David T, Salerno T, Ivanov J . Predictors of operative survival after valve replacement. Circulation. 1988; 78(3 Pt 2):I25-34. View

13.

Svensson L, Atik F, Cosgrove D, Blackstone E, Rajeswaran J, Krishnaswamy G . Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg. 2009; 139(4):926-32.e1-2. DOI: 10.1016/j.jtcvs.2009.09.038. View

14.

Gillinov A, Cosgrove D, Blackstone E, Diaz R, ARNOLD J, Lytle B . Durability of mitral valve repair for degenerative disease. J Thorac Cardiovasc Surg. 1998; 116(5):734-43. DOI: 10.1016/S0022-5223(98)00450-4. View

15.

Akins C, Hilgenberg A, Buckley M, Vlahakes G, Torchiana D, Daggett W . Mitral valve reconstruction versus replacement for degenerative or ischemic mitral regurgitation. Ann Thorac Surg. 1994; 58(3):668-75; discussion 675-6. DOI: 10.1016/0003-4975(94)90725-0. View

16.

Komeda M, David T, Rao V, Sun Z, Weisel R, Burns R . Late hemodynamic effects of the preserved papillary muscles during mitral valve replacement. Circulation. 1994; 90(5 Pt 2):II190-4. View

17.

Suri R, Schaff H, Dearani J, Sundt 3rd T, Daly R, Mullany C . Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg. 2006; 82(3):819-26. DOI: 10.1016/j.athoracsur.2006.03.091. View

18.

Enriquez-Sarano M, Schaff H, Orszulak T, Tajik A, Bailey K, Frye R . Valve repair improves the outcome of surgery for mitral regurgitation. A multivariate analysis. Circulation. 1995; 91(4):1022-8. DOI: 10.1161/01.cir.91.4.1022. View

19.

Thourani V, Weintraub W, Craver J, Jones E, Gott J, Brown 3rd W . Influence of concomitant CABG and urgent/emergent status on mitral valve replacement surgery. Ann Thorac Surg. 2000; 70(3):778-83; discussion 783-4. DOI: 10.1016/s0003-4975(00)01641-6. View

20.

Enriquez-Sarano M, Avierinos J, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V . Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005; 352(9):875-83. DOI: 10.1056/NEJMoa041451. View