MP36. Mitral Valve Repair in a Regional Quality Collaborative: Respect or Resect?
Presented During: Moderated E-Posters
CHARLOTTESVILLE, VA
United States - Contact Me
Dr. Alex Wisniewski is a native of Toledo, OH and is currently an integrated cardiothoracic surgery resident at the University of Virginia. His career interests lie in adult cardiac surgery upon completion of his training. Outside of residency, he hikes frequently around the Blue Ridge mountains in Virginia and travels out west for different snowboarding adventures.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objective: Mitral valve repair is the gold standard for treatment of mitral regurgitation, but the optimal technique remains debated. Utilizing a regional collaborative, we sought to determine the change in repair technique over time, respective outcomes, and predictors of technique usage.
Methods: We identified all patients undergoing mitral valve repair from 2012-2022. Those with endocarditis, undergoing transcatheter repair, or other concomitant procedures including tricuspid intervention or atrial fibrillation ablation were excluded. Continuous variables were analyzed via two-way t-test and categorical variables via chi-square testing. Multiple regression was used to determine outcome predictors.
Results: We identified 1658 patients that underwent isolated mitral valve repair with 948 (57.2%) undergoing a leaflet sparing repair. Over the last decade, there was no significant trend in the proportion of repair techniques across the region via logistic regression (p=0.85). Those undergoing leaflet sparing repairs were more likely to be female (44.0% vs. 34.7%, p<0.001), African American (13.2% vs. 8.3%, p=0.002), redos (6.4% vs. 2.1%, p<0.001), undergo minimally invasive approaches (51.6% vs. 24.1%, p<0.001), and have higher predicted risk of morbidity or mortality (median 8.5% vs. 7.8%, p=0.004). Intraoperatively, leaflet sparing repairs were associated with both longer bypass (138 ± 43 vs. 127 ± 48 minutes, p<0.001) and cross clamp times (96 ± 32 vs. 90 ± 36 minutes, p<0.001) compared to leaflet resection repairs. Operative mortality was similar between both groups (0.95% vs. 0.99%, p=0.94) as were other postoperative outcomes aside from a lower rate of reoperation for valve dysfunction in the leaflet sparing group (0.11% vs. 0.70%, p = 0.04). Anterior leaflet prolapse (OR=7.0, p<0.001) and minimally invasive approach (OR=5.3, p<0.001) were most predictive of leaflet sparing repair.
Conclusion: Despite minor differences in operative times, statewide over the past decade there remains a diverse mix of both classical "resect" and newer "respect" strategies with comparable short-term outcomes and no major timewise trends. These data may suggest that the approaches are either viewed as complementary rather than dichotomous or perhaps are decided on a case-by-case.
Methods: We identified all patients undergoing mitral valve repair from 2012-2022. Those with endocarditis, undergoing transcatheter repair, or other concomitant procedures including tricuspid intervention or atrial fibrillation ablation were excluded. Continuous variables were analyzed via two-way t-test and categorical variables via chi-square testing. Multiple regression was used to determine outcome predictors.
Results: We identified 1658 patients that underwent isolated mitral valve repair with 948 (57.2%) undergoing a leaflet sparing repair. Over the last decade, there was no significant trend in the proportion of repair techniques across the region via logistic regression (p=0.85). Those undergoing leaflet sparing repairs were more likely to be female (44.0% vs. 34.7%, p<0.001), African American (13.2% vs. 8.3%, p=0.002), redos (6.4% vs. 2.1%, p<0.001), undergo minimally invasive approaches (51.6% vs. 24.1%, p<0.001), and have higher predicted risk of morbidity or mortality (median 8.5% vs. 7.8%, p=0.004). Intraoperatively, leaflet sparing repairs were associated with both longer bypass (138 ± 43 vs. 127 ± 48 minutes, p<0.001) and cross clamp times (96 ± 32 vs. 90 ± 36 minutes, p<0.001) compared to leaflet resection repairs. Operative mortality was similar between both groups (0.95% vs. 0.99%, p=0.94) as were other postoperative outcomes aside from a lower rate of reoperation for valve dysfunction in the leaflet sparing group (0.11% vs. 0.70%, p = 0.04). Anterior leaflet prolapse (OR=7.0, p<0.001) and minimally invasive approach (OR=5.3, p<0.001) were most predictive of leaflet sparing repair.
Conclusion: Despite minor differences in operative times, statewide over the past decade there remains a diverse mix of both classical "resect" and newer "respect" strategies with comparable short-term outcomes and no major timewise trends. These data may suggest that the approaches are either viewed as complementary rather than dichotomous or perhaps are decided on a case-by-case.