Impact of Complex Anatomy and Patient Risk Profile in Minimally Invasive Mitral Valve Surgery.
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
30 Aug 2024
30 Aug 2024
Historique:
received:
03
02
2024
revised:
03
06
2024
accepted:
16
07
2024
medline:
2
9
2024
pubmed:
2
9
2024
entrez:
1
9
2024
Statut:
aheadofprint
Résumé
To assess the impact of complex mitral valve disease and patient risk profile on operative outcomes in the large cohort of the Mini-Mitral International Registry (MMIR). Patients were categorized as complex degenerative mitral regurgitation (DMR) (bileaflet or anterior mitral leaflet prolapse/flail) and simple DMR (posterior mitral leaflet prolapse/flail). Subgroup analyses was performed in low risk (EuroSCORE II<8%) and high risk (EuroSCORE II>8%) cohorts. Logistic regression model was applied to investigate the impact of valve anatomy and patient risk factors on valve repair rate and operative risk. The study cohort consisted of 4524 patients with DMR (complex DMR 1296, simple DMR 3228). Valve repair rate was 87.3% and 91% in complex and simple DMR, respectively. Predictors of valve replacement were anterior leaflet prolapse/flail, bileaflet flail, female gender, age and reoperation, whereas Barlow's disease was protective. Clinical results were comparable between complex and simple DMR. On subgroup analyses, high-risk patients showed less satisfactory outcomes with respect to both the valve repair and operative mortality rates. Our findings suggest that complex DMR can be satisfactorily addressed using minimally invasive techniques. However, while complex disease was associated with low operative risk, anterior leaflet lesions and bileaflet flail remain negative predictors of successful valve repair. Conversely, valve repair rate was less satisfactory in high-risk patients, regardless of DMR complexity.
Sections du résumé
BACKGROUND
BACKGROUND
To assess the impact of complex mitral valve disease and patient risk profile on operative outcomes in the large cohort of the Mini-Mitral International Registry (MMIR).
METHODS
METHODS
Patients were categorized as complex degenerative mitral regurgitation (DMR) (bileaflet or anterior mitral leaflet prolapse/flail) and simple DMR (posterior mitral leaflet prolapse/flail). Subgroup analyses was performed in low risk (EuroSCORE II<8%) and high risk (EuroSCORE II>8%) cohorts. Logistic regression model was applied to investigate the impact of valve anatomy and patient risk factors on valve repair rate and operative risk.
RESULTS
RESULTS
The study cohort consisted of 4524 patients with DMR (complex DMR 1296, simple DMR 3228). Valve repair rate was 87.3% and 91% in complex and simple DMR, respectively. Predictors of valve replacement were anterior leaflet prolapse/flail, bileaflet flail, female gender, age and reoperation, whereas Barlow's disease was protective. Clinical results were comparable between complex and simple DMR. On subgroup analyses, high-risk patients showed less satisfactory outcomes with respect to both the valve repair and operative mortality rates.
CONCLUSIONS
CONCLUSIONS
Our findings suggest that complex DMR can be satisfactorily addressed using minimally invasive techniques. However, while complex disease was associated with low operative risk, anterior leaflet lesions and bileaflet flail remain negative predictors of successful valve repair. Conversely, valve repair rate was less satisfactory in high-risk patients, regardless of DMR complexity.
Identifiants
pubmed: 39218343
pii: S0003-4975(24)00699-4
doi: 10.1016/j.athoracsur.2024.07.050
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.