The Impact of Mitral Disease Etiology on Operative Mortality After Mitral Valve Operations

J. Scott Rankin*, Maria Grau-Sepulveda, David M. Shahian, A. Marc Gillinov, Rakesh Suri, James S. Gammie, Steven F. Bolling, Patrick M McCarthy, Vinod H. Thourani, Niv Ad, Sean M. O'Brien, Jeffrey P. Jacobs, Vinay Badhwar

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: The pathoetiology of mitral regurgitation (MR) has been suggested as a mediator of outcomes after mitral valve (MV) operations, particularly in ischemic functional mitral regurgitation (IMR). This study examined the independent association of MV etiology with mortality. Methods: The Society of Thoracic Surgeons Database was utilized to assess all patients undergoing MV replacement or repair from 2011 to 2014. Patients who underwent concomitant surgical ablation, septal defect closure, tricuspid valve repair, or coronary artery bypass grafting were included. All other concomitant operations were excluded, producing a final cohort of 89,085 patients. A hierarchical etiology decision tree was developed to categorize the population into eight etiology groups: endocarditis, reoperation, acute IMR, rheumatic, uncommon etiologies (hypertrophic obstructive cardiomyopathy, trauma, tumor, or congenital), degenerative primary MR, chronic IMR, and pure annular dilatation. The statistical association of etiology with unadjusted and risk-adjusted operative mortality was evaluated by logistic regression and supplemented by sensitivity analyses using established risk models. Results: The decision tree showed that etiology categories appeared clinically aligned with published population distributions, baseline characteristics, and unadjusted outcomes. Unadjusted operative mortality ranged from 1.2% for degenerative MV repair to 15.1% for MV replacement in acute IMR. After risk adjustment, MV etiologies per se exhibited insignificant independent associations with risk-adjusted operative mortality. Conclusions: Mortality after mitral operations is determined primarily by standard clinical risk factors. Mitral etiology does not appear to add independent predictive value.

Original languageEnglish (US)
Pages (from-to)1406-1413
Number of pages8
JournalAnnals of Thoracic Surgery
Volume106
Issue number5
DOIs
StatePublished - Nov 1 2018

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Mitral Valve Insufficiency
Mitral Valve
Mortality
Decision Trees
Risk Adjustment
Tricuspid Valve
Hypertrophic Cardiomyopathy
Endocarditis
Reoperation
Coronary Artery Bypass
Dilatation
Logistic Models
Demography
Databases
Wounds and Injuries
Population
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Rankin, J. S., Grau-Sepulveda, M., Shahian, D. M., Gillinov, A. M., Suri, R., Gammie, J. S., ... Badhwar, V. (2018). The Impact of Mitral Disease Etiology on Operative Mortality After Mitral Valve Operations. Annals of Thoracic Surgery, 106(5), 1406-1413. https://doi.org/10.1016/j.athoracsur.2018.04.053
Rankin, J. Scott ; Grau-Sepulveda, Maria ; Shahian, David M. ; Gillinov, A. Marc ; Suri, Rakesh ; Gammie, James S. ; Bolling, Steven F. ; McCarthy, Patrick M ; Thourani, Vinod H. ; Ad, Niv ; O'Brien, Sean M. ; Jacobs, Jeffrey P. ; Badhwar, Vinay. / The Impact of Mitral Disease Etiology on Operative Mortality After Mitral Valve Operations. In: Annals of Thoracic Surgery. 2018 ; Vol. 106, No. 5. pp. 1406-1413.
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abstract = "Background: The pathoetiology of mitral regurgitation (MR) has been suggested as a mediator of outcomes after mitral valve (MV) operations, particularly in ischemic functional mitral regurgitation (IMR). This study examined the independent association of MV etiology with mortality. Methods: The Society of Thoracic Surgeons Database was utilized to assess all patients undergoing MV replacement or repair from 2011 to 2014. Patients who underwent concomitant surgical ablation, septal defect closure, tricuspid valve repair, or coronary artery bypass grafting were included. All other concomitant operations were excluded, producing a final cohort of 89,085 patients. A hierarchical etiology decision tree was developed to categorize the population into eight etiology groups: endocarditis, reoperation, acute IMR, rheumatic, uncommon etiologies (hypertrophic obstructive cardiomyopathy, trauma, tumor, or congenital), degenerative primary MR, chronic IMR, and pure annular dilatation. The statistical association of etiology with unadjusted and risk-adjusted operative mortality was evaluated by logistic regression and supplemented by sensitivity analyses using established risk models. Results: The decision tree showed that etiology categories appeared clinically aligned with published population distributions, baseline characteristics, and unadjusted outcomes. Unadjusted operative mortality ranged from 1.2{\%} for degenerative MV repair to 15.1{\%} for MV replacement in acute IMR. After risk adjustment, MV etiologies per se exhibited insignificant independent associations with risk-adjusted operative mortality. Conclusions: Mortality after mitral operations is determined primarily by standard clinical risk factors. Mitral etiology does not appear to add independent predictive value.",
author = "Rankin, {J. Scott} and Maria Grau-Sepulveda and Shahian, {David M.} and Gillinov, {A. Marc} and Rakesh Suri and Gammie, {James S.} and Bolling, {Steven F.} and McCarthy, {Patrick M} and Thourani, {Vinod H.} and Niv Ad and O'Brien, {Sean M.} and Jacobs, {Jeffrey P.} and Vinay Badhwar",
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Rankin, JS, Grau-Sepulveda, M, Shahian, DM, Gillinov, AM, Suri, R, Gammie, JS, Bolling, SF, McCarthy, PM, Thourani, VH, Ad, N, O'Brien, SM, Jacobs, JP & Badhwar, V 2018, 'The Impact of Mitral Disease Etiology on Operative Mortality After Mitral Valve Operations', Annals of Thoracic Surgery, vol. 106, no. 5, pp. 1406-1413. https://doi.org/10.1016/j.athoracsur.2018.04.053

The Impact of Mitral Disease Etiology on Operative Mortality After Mitral Valve Operations. / Rankin, J. Scott; Grau-Sepulveda, Maria; Shahian, David M.; Gillinov, A. Marc; Suri, Rakesh; Gammie, James S.; Bolling, Steven F.; McCarthy, Patrick M; Thourani, Vinod H.; Ad, Niv; O'Brien, Sean M.; Jacobs, Jeffrey P.; Badhwar, Vinay.

In: Annals of Thoracic Surgery, Vol. 106, No. 5, 01.11.2018, p. 1406-1413.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The Impact of Mitral Disease Etiology on Operative Mortality After Mitral Valve Operations

AU - Rankin, J. Scott

AU - Grau-Sepulveda, Maria

AU - Shahian, David M.

AU - Gillinov, A. Marc

AU - Suri, Rakesh

AU - Gammie, James S.

AU - Bolling, Steven F.

AU - McCarthy, Patrick M

AU - Thourani, Vinod H.

AU - Ad, Niv

AU - O'Brien, Sean M.

AU - Jacobs, Jeffrey P.

AU - Badhwar, Vinay

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: The pathoetiology of mitral regurgitation (MR) has been suggested as a mediator of outcomes after mitral valve (MV) operations, particularly in ischemic functional mitral regurgitation (IMR). This study examined the independent association of MV etiology with mortality. Methods: The Society of Thoracic Surgeons Database was utilized to assess all patients undergoing MV replacement or repair from 2011 to 2014. Patients who underwent concomitant surgical ablation, septal defect closure, tricuspid valve repair, or coronary artery bypass grafting were included. All other concomitant operations were excluded, producing a final cohort of 89,085 patients. A hierarchical etiology decision tree was developed to categorize the population into eight etiology groups: endocarditis, reoperation, acute IMR, rheumatic, uncommon etiologies (hypertrophic obstructive cardiomyopathy, trauma, tumor, or congenital), degenerative primary MR, chronic IMR, and pure annular dilatation. The statistical association of etiology with unadjusted and risk-adjusted operative mortality was evaluated by logistic regression and supplemented by sensitivity analyses using established risk models. Results: The decision tree showed that etiology categories appeared clinically aligned with published population distributions, baseline characteristics, and unadjusted outcomes. Unadjusted operative mortality ranged from 1.2% for degenerative MV repair to 15.1% for MV replacement in acute IMR. After risk adjustment, MV etiologies per se exhibited insignificant independent associations with risk-adjusted operative mortality. Conclusions: Mortality after mitral operations is determined primarily by standard clinical risk factors. Mitral etiology does not appear to add independent predictive value.

AB - Background: The pathoetiology of mitral regurgitation (MR) has been suggested as a mediator of outcomes after mitral valve (MV) operations, particularly in ischemic functional mitral regurgitation (IMR). This study examined the independent association of MV etiology with mortality. Methods: The Society of Thoracic Surgeons Database was utilized to assess all patients undergoing MV replacement or repair from 2011 to 2014. Patients who underwent concomitant surgical ablation, septal defect closure, tricuspid valve repair, or coronary artery bypass grafting were included. All other concomitant operations were excluded, producing a final cohort of 89,085 patients. A hierarchical etiology decision tree was developed to categorize the population into eight etiology groups: endocarditis, reoperation, acute IMR, rheumatic, uncommon etiologies (hypertrophic obstructive cardiomyopathy, trauma, tumor, or congenital), degenerative primary MR, chronic IMR, and pure annular dilatation. The statistical association of etiology with unadjusted and risk-adjusted operative mortality was evaluated by logistic regression and supplemented by sensitivity analyses using established risk models. Results: The decision tree showed that etiology categories appeared clinically aligned with published population distributions, baseline characteristics, and unadjusted outcomes. Unadjusted operative mortality ranged from 1.2% for degenerative MV repair to 15.1% for MV replacement in acute IMR. After risk adjustment, MV etiologies per se exhibited insignificant independent associations with risk-adjusted operative mortality. Conclusions: Mortality after mitral operations is determined primarily by standard clinical risk factors. Mitral etiology does not appear to add independent predictive value.

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Rankin JS, Grau-Sepulveda M, Shahian DM, Gillinov AM, Suri R, Gammie JS et al. The Impact of Mitral Disease Etiology on Operative Mortality After Mitral Valve Operations. Annals of Thoracic Surgery. 2018 Nov 1;106(5):1406-1413. https://doi.org/10.1016/j.athoracsur.2018.04.053