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The expanding role of mitral valve repair in triple valve operations: contemporary North American outcomes in 8,021 patients.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2014 May; Vol. 97 (5), pp. 1513-9; discussion 1519. Date of Electronic Publication: 2014 Mar 27. - Publication Year :
- 2014
-
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.<br />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.<br />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.<br />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.<br /> (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Age Factors
Aged
Cohort Studies
Combined Modality Therapy
Databases, Factual
Female
Follow-Up Studies
Heart Valve Diseases diagnosis
Heart Valve Diseases mortality
Heart Valve Prosthesis Implantation mortality
Humans
Male
Middle Aged
North America
Postoperative Complications mortality
Postoperative Complications physiopathology
Retrospective Studies
Risk Assessment
Sex Factors
Societies, Medical
Survival Analysis
Treatment Outcome
Aortic Valve surgery
Heart Valve Diseases surgery
Heart Valve Prosthesis Implantation methods
Hospital Mortality trends
Mitral Valve surgery
Tricuspid Valve surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 97
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 24680034
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2014.02.025