Impact of timing and surgical approach on outcomes after mitral valve regurgitation operations

Louis Mathieu Stevens, Evelio Rodriguez, Eric J. Lehr, Linda C. Kindell, L. Wiley Nifong, T. Bruce Ferguson, W. Randolph Chitwood

    Research output: Contribution to journalArticle

    22 Citations (Scopus)

    Abstract

    Background: This study investigated whether the timing of mitral valve (MV) repair or surgical approach affects outcomes in patients with MV regurgitation. Methods: Between 1992 and 2009, 2,255 patients underwent MV operations, including 1,305 with isolated MV regurgitation operations (1,054 repairs, 251 replacements). Surgical approaches were sternotomy in 377, video-assisted right minithoracotomy in 481, or robot-assisted in 447. Mean follow-up was 6.4 ± 4.5 years (maximum, 19 years). Results: Sternotomy MV repairs decreased during the study while minimally invasive MV repairs increased. Robotic MV repair patients were younger, with fewer women, had better left ventricular ejection fractions, and were more likely to have myxomatous degeneration (all p < 0.001). The robotic approach led to a higher MV repair rate and increased use of leaflet/chordal procedures but had longer cardiopulmonary bypass and aortic cross-clamp times (all p < 0.001). The 30-day mortality for isolated MV repair was similar for all approaches (p = 0.409). Fewer neurological events were observed in the videoscopic and robotic groups (p = 0.013). Adjusted survival was similar for all approaches (p = 0.357). Survival in patients in New York Heart Association class I to II with myxomatous degeneration or annular dilatation was similar to a matched population but was worse for patients in class III to IV or undergoing MV replacement. Conclusions: MV repair in patients with severe MV regurgitation should be performed before New York Heart Association class III to IV symptoms develop. Minimally invasive MV repair techniques render similar outcomes as the sternotomy approach.

    Original languageEnglish (US)
    Pages (from-to)1462-1468
    Number of pages7
    JournalAnnals of Thoracic Surgery
    Volume93
    Issue number5
    DOIs
    StatePublished - May 1 2012

    Fingerprint

    Mitral Valve Insufficiency
    Mitral Valve
    Sternotomy
    Robotics
    Survival
    Cardiopulmonary Bypass
    Stroke Volume
    Dilatation
    Mortality

    All Science Journal Classification (ASJC) codes

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

    Cite this

    Stevens, L. M., Rodriguez, E., Lehr, E. J., Kindell, L. C., Nifong, L. W., Ferguson, T. B., & Chitwood, W. R. (2012). Impact of timing and surgical approach on outcomes after mitral valve regurgitation operations. Annals of Thoracic Surgery, 93(5), 1462-1468. https://doi.org/10.1016/j.athoracsur.2012.01.016

    Impact of timing and surgical approach on outcomes after mitral valve regurgitation operations. / Stevens, Louis Mathieu; Rodriguez, Evelio; Lehr, Eric J.; Kindell, Linda C.; Nifong, L. Wiley; Ferguson, T. Bruce; Chitwood, W. Randolph.

    In: Annals of Thoracic Surgery, Vol. 93, No. 5, 01.05.2012, p. 1462-1468.

    Research output: Contribution to journalArticle

    Stevens, LM, Rodriguez, E, Lehr, EJ, Kindell, LC, Nifong, LW, Ferguson, TB & Chitwood, WR 2012, 'Impact of timing and surgical approach on outcomes after mitral valve regurgitation operations', Annals of Thoracic Surgery, vol. 93, no. 5, pp. 1462-1468. https://doi.org/10.1016/j.athoracsur.2012.01.016
    Stevens, Louis Mathieu ; Rodriguez, Evelio ; Lehr, Eric J. ; Kindell, Linda C. ; Nifong, L. Wiley ; Ferguson, T. Bruce ; Chitwood, W. Randolph. / Impact of timing and surgical approach on outcomes after mitral valve regurgitation operations. In: Annals of Thoracic Surgery. 2012 ; Vol. 93, No. 5. pp. 1462-1468.
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    AU - Stevens, Louis Mathieu

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    AU - Lehr, Eric J.

    AU - Kindell, Linda C.

    AU - Nifong, L. Wiley

    AU - Ferguson, T. Bruce

    AU - Chitwood, W. Randolph

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    N2 - Background: This study investigated whether the timing of mitral valve (MV) repair or surgical approach affects outcomes in patients with MV regurgitation. Methods: Between 1992 and 2009, 2,255 patients underwent MV operations, including 1,305 with isolated MV regurgitation operations (1,054 repairs, 251 replacements). Surgical approaches were sternotomy in 377, video-assisted right minithoracotomy in 481, or robot-assisted in 447. Mean follow-up was 6.4 ± 4.5 years (maximum, 19 years). Results: Sternotomy MV repairs decreased during the study while minimally invasive MV repairs increased. Robotic MV repair patients were younger, with fewer women, had better left ventricular ejection fractions, and were more likely to have myxomatous degeneration (all p < 0.001). The robotic approach led to a higher MV repair rate and increased use of leaflet/chordal procedures but had longer cardiopulmonary bypass and aortic cross-clamp times (all p < 0.001). The 30-day mortality for isolated MV repair was similar for all approaches (p = 0.409). Fewer neurological events were observed in the videoscopic and robotic groups (p = 0.013). Adjusted survival was similar for all approaches (p = 0.357). Survival in patients in New York Heart Association class I to II with myxomatous degeneration or annular dilatation was similar to a matched population but was worse for patients in class III to IV or undergoing MV replacement. Conclusions: MV repair in patients with severe MV regurgitation should be performed before New York Heart Association class III to IV symptoms develop. Minimally invasive MV repair techniques render similar outcomes as the sternotomy approach.

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