Mitral valve repair for primary mitral regurgitation demonstrated a contemporary 30-day operative mortality risk of 1.16%, with the derived risk model showing excellent discrimination (AUC 0.807).
Cohort (n=53,462)
Yes
A novel risk model establishes that the contemporary 30-day mortality risk of surgical mitral valve repair for primary mitral regurgitation is very low, at less than 1% for the vast majority of patients.
BACKGROUND Risk estimation for surgical intervention is an essential component of heart team shared decision-making. However, current mitral valve (MV) surgery risk models used in practice lack etiologic or procedural specificity. OBJECTIVES The purpose of this study was to establish a comprehensive method for assessment of operative risk of MV repair of primary mitral regurgitation (MR). METHODS A novel etiology and procedure-specific algorithm identified 53,462 consecutive (July 2014 to June 2020) intention-to-treat MV repair patients with primary MR from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Risk models were fit for 30-day operative mortality, mortality and/or major morbidity, and conversion-to-replacement (CONV). As-treated mortality and morbidity models were derived separately. RESULTS Event rates for mortality (n = 619; 1.16%), mortality plus morbidity (n = 4,746; 8.88%), and CONV (n = 3,399; 6.36%) were low. Mortality was higher in CONV patients vs repair (3.18% vs 1.02%). All event rates were lower with increasing program volumes. The mortality risk model had excellent discrimination (AUC: 0.807) and calibration and confirmed very low mortality risk for isolated MV repair for primary MR, with mean mortality risk of 1.16% and median of 0.55% (IQR: 0.30%-1.17%) with 90th and 95th percentiles 2.48% and 3.99%, respectively. The mortality risk was 3% estimated risk of mortality. CONCLUSIONS This etiologic and procedure-specific risk model establishes that the contemporary mortality risk of MV repair for primary MR is <1% for the vast majority of patients.
“Past perceptions of the risk of surgery and repair rates based on older risk models may have influenced the design of two clinical trials to explore transcatheter therapy in lower risk older individuals. The finding of 90% successful surgical repair with less than 1% mortality now achieved in the USA sets the outcome bar fairly high when considering alternative therapies to surgery. We hope this information will help physicians and patients make more informed decisions regarding treatment, as well as to inform the optimal design of future trials in the field.”
Badhwar et al. (Wed,) conducted a cohort in Primary mitral regurgitation (n=53,462). Mitral valve repair was evaluated on 30-day operative mortality. Mitral valve repair for primary mitral regurgitation demonstrated a contemporary 30-day operative mortality risk of 1.16%, with the derived risk model showing excellent discrimination (AUC 0.807).