The expanding role of mitral valve repair in triple valve operations: Contemporary north american outcomes in 8,021 patients

Rakesh M. Suri, Vinod H. Thourani, Brian R. Englum, J. Scott Rankin, Vinay Badhwar, Lars G. Svensson, Gorav Ailawadi, Michael J. MacK, Max He, J. Matthew Brennan, Hartzell V Schaff, James S. Gammie

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Although the operative risk of multivalve operations has historically been high, current outcomes are poorly understood. We sought to evaluate factors influencing contemporary results of triple-valve operations using The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Methods Among patients undergoing combined mitral, aortic, and tricuspid valve (triple- valve) operations between 1993 and 2011, aortic valve repair patients were excluded and those having aortic valve replacement were analyzed according to whether they underwent repair vs replacement of the mitral valve (MV) and tricuspid valve (TV). Temporal trends in operative death and clinical outcomes were examined using unadjusted and adjusted analyses. Results A total of 8,021 triple-valve patients were studied. The median (25th percentile, 75th percentile) age was 67 years (59, 77 years), 4,809 (60%) were women, 4,488 (56%) had New York Heart Association class III to IV symptoms, and the mean (25th percentile, 75th percentile) ejection fraction was 50% (40%, 60%). MV repair was performed in 2,728 (34%) patients overall and increased over time from 13% (1993 to 1997) to 41% (2008 to 2011). TV repair was performed in 7,512 (94%) patients overall and increased over time from 86% (1993 to 1997) to 96% (2008 to 2011). Unadjusted operative mortality decreased from 17% in 1993 to 9% in 2011. Adjusted odds ratios (95% confidence intervals) of operative mortality were lower in those having MV repair (0.72 [0.61 to 0.85]), TV repair (0.64 [0.50 to 0.83]), and MV + TV repair (0.46 [0.34 to 0.63]) compared with those having replacements. Unadjusted and adjusted odds of stroke were similar between groups and not significant for all. Conclusions This large series demonstrates that surgical results of triple-valve operations have continued to improve during the past 18 years. MV and TV repair were associated with improvements in early survival. Although further study is required to understand late outcomes, these data suggest that broader efforts to perform MV repair instead of replacement in this high-risk patient population appear warranted.

Original languageEnglish (US)
Pages (from-to)1513-1519
Number of pages7
JournalAnnals of Thoracic Surgery
Volume97
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Tricuspid Valve
Mitral Valve
Aortic Valve
Mortality
Thoracic Surgery
Stroke
Odds Ratio
Databases
Confidence Intervals
Survival
Population

ASJC Scopus subject areas

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

Cite this

Suri, R. M., Thourani, V. H., Englum, B. R., Rankin, J. S., Badhwar, V., Svensson, L. G., ... Gammie, J. S. (2014). The expanding role of mitral valve repair in triple valve operations: Contemporary north american outcomes in 8,021 patients. Annals of Thoracic Surgery, 97(5), 1513-1519. https://doi.org/10.1016/j.athoracsur.2014.02.025

The expanding role of mitral valve repair in triple valve operations : Contemporary north american outcomes in 8,021 patients. / Suri, Rakesh M.; Thourani, Vinod H.; Englum, Brian R.; Rankin, J. Scott; Badhwar, Vinay; Svensson, Lars G.; Ailawadi, Gorav; MacK, Michael J.; He, Max; Brennan, J. Matthew; Schaff, Hartzell V; Gammie, James S.

In: Annals of Thoracic Surgery, Vol. 97, No. 5, 2014, p. 1513-1519.

Research output: Contribution to journalArticle

Suri, RM, Thourani, VH, Englum, BR, Rankin, JS, Badhwar, V, Svensson, LG, Ailawadi, G, MacK, MJ, He, M, Brennan, JM, Schaff, HV & Gammie, JS 2014, 'The expanding role of mitral valve repair in triple valve operations: Contemporary north american outcomes in 8,021 patients', Annals of Thoracic Surgery, vol. 97, no. 5, pp. 1513-1519. https://doi.org/10.1016/j.athoracsur.2014.02.025
Suri, Rakesh M. ; Thourani, Vinod H. ; Englum, Brian R. ; Rankin, J. Scott ; Badhwar, Vinay ; Svensson, Lars G. ; Ailawadi, Gorav ; MacK, Michael J. ; He, Max ; Brennan, J. Matthew ; Schaff, Hartzell V ; Gammie, James S. / The expanding role of mitral valve repair in triple valve operations : Contemporary north american outcomes in 8,021 patients. In: Annals of Thoracic Surgery. 2014 ; Vol. 97, No. 5. pp. 1513-1519.
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abstract = "Background Although the operative risk of multivalve operations has historically been high, current outcomes are poorly understood. We sought to evaluate factors influencing contemporary results of triple-valve operations using The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Methods Among patients undergoing combined mitral, aortic, and tricuspid valve (triple- valve) operations between 1993 and 2011, aortic valve repair patients were excluded and those having aortic valve replacement were analyzed according to whether they underwent repair vs replacement of the mitral valve (MV) and tricuspid valve (TV). Temporal trends in operative death and clinical outcomes were examined using unadjusted and adjusted analyses. Results A total of 8,021 triple-valve patients were studied. The median (25th percentile, 75th percentile) age was 67 years (59, 77 years), 4,809 (60{\%}) were women, 4,488 (56{\%}) had New York Heart Association class III to IV symptoms, and the mean (25th percentile, 75th percentile) ejection fraction was 50{\%} (40{\%}, 60{\%}). MV repair was performed in 2,728 (34{\%}) patients overall and increased over time from 13{\%} (1993 to 1997) to 41{\%} (2008 to 2011). TV repair was performed in 7,512 (94{\%}) patients overall and increased over time from 86{\%} (1993 to 1997) to 96{\%} (2008 to 2011). Unadjusted operative mortality decreased from 17{\%} in 1993 to 9{\%} in 2011. Adjusted odds ratios (95{\%} confidence intervals) of operative mortality were lower in those having MV repair (0.72 [0.61 to 0.85]), TV repair (0.64 [0.50 to 0.83]), and MV + TV repair (0.46 [0.34 to 0.63]) compared with those having replacements. Unadjusted and adjusted odds of stroke were similar between groups and not significant for all. Conclusions This large series demonstrates that surgical results of triple-valve operations have continued to improve during the past 18 years. MV and TV repair were associated with improvements in early survival. Although further study is required to understand late outcomes, these data suggest that broader efforts to perform MV repair instead of replacement in this high-risk patient population appear warranted.",
author = "Suri, {Rakesh M.} and Thourani, {Vinod H.} and Englum, {Brian R.} and Rankin, {J. Scott} and Vinay Badhwar and Svensson, {Lars G.} and Gorav Ailawadi and MacK, {Michael J.} and Max He and Brennan, {J. Matthew} and Schaff, {Hartzell V} and Gammie, {James S.}",
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T1 - The expanding role of mitral valve repair in triple valve operations

T2 - Contemporary north american outcomes in 8,021 patients

AU - Suri, Rakesh M.

AU - Thourani, Vinod H.

AU - Englum, Brian R.

AU - Rankin, J. Scott

AU - Badhwar, Vinay

AU - Svensson, Lars G.

AU - Ailawadi, Gorav

AU - MacK, Michael J.

AU - He, Max

AU - Brennan, J. Matthew

AU - Schaff, Hartzell V

AU - Gammie, James S.

PY - 2014

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N2 - Background Although the operative risk of multivalve operations has historically been high, current outcomes are poorly understood. We sought to evaluate factors influencing contemporary results of triple-valve operations using The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Methods Among patients undergoing combined mitral, aortic, and tricuspid valve (triple- valve) operations between 1993 and 2011, aortic valve repair patients were excluded and those having aortic valve replacement were analyzed according to whether they underwent repair vs replacement of the mitral valve (MV) and tricuspid valve (TV). Temporal trends in operative death and clinical outcomes were examined using unadjusted and adjusted analyses. Results A total of 8,021 triple-valve patients were studied. The median (25th percentile, 75th percentile) age was 67 years (59, 77 years), 4,809 (60%) were women, 4,488 (56%) had New York Heart Association class III to IV symptoms, and the mean (25th percentile, 75th percentile) ejection fraction was 50% (40%, 60%). MV repair was performed in 2,728 (34%) patients overall and increased over time from 13% (1993 to 1997) to 41% (2008 to 2011). TV repair was performed in 7,512 (94%) patients overall and increased over time from 86% (1993 to 1997) to 96% (2008 to 2011). Unadjusted operative mortality decreased from 17% in 1993 to 9% in 2011. Adjusted odds ratios (95% confidence intervals) of operative mortality were lower in those having MV repair (0.72 [0.61 to 0.85]), TV repair (0.64 [0.50 to 0.83]), and MV + TV repair (0.46 [0.34 to 0.63]) compared with those having replacements. Unadjusted and adjusted odds of stroke were similar between groups and not significant for all. Conclusions This large series demonstrates that surgical results of triple-valve operations have continued to improve during the past 18 years. MV and TV repair were associated with improvements in early survival. Although further study is required to understand late outcomes, these data suggest that broader efforts to perform MV repair instead of replacement in this high-risk patient population appear warranted.

AB - Background Although the operative risk of multivalve operations has historically been high, current outcomes are poorly understood. We sought to evaluate factors influencing contemporary results of triple-valve operations using The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Methods Among patients undergoing combined mitral, aortic, and tricuspid valve (triple- valve) operations between 1993 and 2011, aortic valve repair patients were excluded and those having aortic valve replacement were analyzed according to whether they underwent repair vs replacement of the mitral valve (MV) and tricuspid valve (TV). Temporal trends in operative death and clinical outcomes were examined using unadjusted and adjusted analyses. Results A total of 8,021 triple-valve patients were studied. The median (25th percentile, 75th percentile) age was 67 years (59, 77 years), 4,809 (60%) were women, 4,488 (56%) had New York Heart Association class III to IV symptoms, and the mean (25th percentile, 75th percentile) ejection fraction was 50% (40%, 60%). MV repair was performed in 2,728 (34%) patients overall and increased over time from 13% (1993 to 1997) to 41% (2008 to 2011). TV repair was performed in 7,512 (94%) patients overall and increased over time from 86% (1993 to 1997) to 96% (2008 to 2011). Unadjusted operative mortality decreased from 17% in 1993 to 9% in 2011. Adjusted odds ratios (95% confidence intervals) of operative mortality were lower in those having MV repair (0.72 [0.61 to 0.85]), TV repair (0.64 [0.50 to 0.83]), and MV + TV repair (0.46 [0.34 to 0.63]) compared with those having replacements. Unadjusted and adjusted odds of stroke were similar between groups and not significant for all. Conclusions This large series demonstrates that surgical results of triple-valve operations have continued to improve during the past 18 years. MV and TV repair were associated with improvements in early survival. Although further study is required to understand late outcomes, these data suggest that broader efforts to perform MV repair instead of replacement in this high-risk patient population appear warranted.

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