Abstract
Importance: Early surgery for severe primary degenerative mitral regurgitation is recommended, provided optimal outcomes are achievable. Contemporary national data defining mitral valve surgery volume and outcomes are lacking. Objective: To assess national 30-day and 1-year outcomes of mitral valve surgery and define the hospital- and surgeon-level volume-outcome association with mitral valve repair or replacement (MVRR) in patients with primary mitral regurgitation. Design, Setting, and Participants: This multicenter cross-sectional observational study used the Society of Thoracic Surgeons Adult Cardiac Surgery Database to identify patients undergoing isolated MVRR for primary mitral regurgitation in the United States. Operative data were collected from July 1, 2011, to December 31, 2016, and analyzed from March 1 to July 1, 2019, with data linked to the Centers for Medicare and Medicaid Services. Main Outcomes and Measures: The primary outcome was 30-day in-hospital operative mortality after isolated MVRR for primary mitral regurgitation. Secondary outcomes were 30-day composite mortality plus morbidity (any occurrence of bleeding, stroke, prolonged ventilation, renal failure, or deep wound infection), rate of successful mitral valve repair of primary mitral regurgitation (residual mitral regurgitation of mild [1+] or better), and 1-year mortality, reoperation, and rehospitalization for heart failure. Results: A total of 55311 patients, 1094 hospitals, and 2410 surgeons were identified. Increasing hospital and surgeon volumes were associated with lower risk-adjusted 30-day mortality, lower 30-day composite mortality plus morbidity, and higher rate of successful repair. The lowest vs highest hospital volume quartile had higher 1-year risk-adjusted mortality (hazard ratio [HR], 1.61, 95% CI, 1.31-1.98), but not mitral reoperation (odds ratio [OR], 1.51; 95% CI, 0.81-2.78) or hospitalization for heart failure (HR, 1.25; 95% CI, 0.96-1.64). The surgeon-level 1-year volume-outcome associations were similar for mortality (HR, 1.60; 95% CI, 1.32-1.94) but not significant for mitral reoperation (HR, 1.14; 95% CI, 0.60-2.18) or hospitalization for heart failure (HR, 1.17; 95% CI, 0.91-1.50). Conclusions and Relevance: National hospital- and surgeon-level inverse volume-outcome associations were observed for 30-day and 1-year mortality after mitral valve surgery for primary mitral regurgitation. These findings may help to define access to experienced centers and surgeons for the management of primary mitral regurgitation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1092-1101 |
| Number of pages | 10 |
| Journal | JAMA cardiology |
| Volume | 5 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 2020 |
Funding
reported nonfinancial support from Abbott Laboratories outside the submitted work. Dr Vemulapalli reported receiving grants from the Society of Thoracic Surgeons during the conduct of the study; grants from Abbott Vascular, Boston Scientific Corporation, the National Institutes of Health, the Patient-Centered Outcomes Research Institute, and the American College of Cardiology outside the submitted work; and consulting for AdBoard Media, Ltd, Boston Scientific Corporation, Janssen Pharmaceutica, and Bay Labs (Caption Health). Dr Mack reported nonfinancial support from Edwards Lifesciences, Medtronic plc, and Abbott Laboratories outside the submitted work. Dr Gillinov reported receiving personal fees from Edwards Lifesciences, Medtronic plc, Abbott Laboratories, CryoLife, Inc, AtriCure, Inc, Johnson & Johnson, and ClearFlow, Inc, outside the submitted work and having a patent to Methods for Mitral Valve Repair issued and licensed. Dr Chikwe reported Cedars-Sinai Medical Center receiving fees from Edwards Lifesciences and Medtronic plc for speaker and consulting activities. Dr McCarthy reported receiving grants and personal fees from Edwards Lifesciences, Abbott Vascular, and AtriCure, Inc, outside the submitted work. Dr Thourani reported receiving grants and personal fees from Edwards Lifesciences, Abbott Vascular, Gore Vascular, and Boston Scientific Corporation outside the submitted work. Dr Edgerton reported receiving personal fees from AtriCure, Inc, outside the submitted work. Dr Gammie reported receiving grants and personal fees from Edwards Lifesciences during the conduct of the study. No other disclosures were reported. sponsored and funded by The Society of Thoracic Surgeons. Dr Habib, Director of Research for the Society of Thoracic Surgeons, was a coauthor, and Dr Dearani is the president of the Society of Thoracic Surgeons. The nonindustry sponsor had no role in the collection, analysis, and interpretation of the data, but did provide endorsement of the decision to submit the manuscript for publication.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine