Faculty Collaboration Database

Mitral valve surgery in the US Veterans Administration health system: 10-year outcomes and trends. J Thorac Cardiovasc Surg 2018 Jan;155(1):105-117.e5

Date

10/28/2017

Pubmed ID

29074046

DOI

10.1016/j.jtcvs.2017.07.089

Scopus ID

2-s2.0-85037599759 (requires institutional sign-in at Scopus site)   23 Citations

Abstract

OBJECTIVE: To compare mitral valve repair (MVRepair) and mitral valve replacement (MVReplace) trends in the Veterans Affairs (VA) Surgical Quality Improvement Program.

METHODS: Trends were compared by bivariate analyses, followed by backward stepwise selection and multivariable logistic modeling to determine the effect of preoperative comorbidities and facility-level factors on MVRepair (vs MVReplace) rate. A subgroup analysis focused on patients who underwent elective surgery for isolated primary degenerative mitral regurgitation. Propensity matching was done in the overall and primary degenerative cohorts.

RESULTS: From October 2000 to October 2013, 4165 veterans underwent MVRepair (n = 2408) or MVReplace (n = 1757) for MV disease of any cause at 40 VA medical centers (procedural volume, 0-29/y; median 7/y). The MVRepair percentage increased from 48% in 2001 to 63% in 2013 (P < .001). MVRepair rates varied widely among centers; center volume explained only 19% of this variation after adjustment for case mix (R² = 0.19, P = .005). Unadjusted 30-day and 1-year mortality rates were lower after MVRepair than after MVReplace (3.5% vs 4.8%, P = .04; 9.8% vs 12.1%, P = .02). Among the propensity-matched patients (n = 2520), 30-day and 1-year mortality were similar after MVRepair and MVReplace. In the propensity-matched primary degenerative subgroup (n = 664), unadjusted long-term mortality for up to 10 years postoperatively was lower after MVRepair (28% vs 37%, P = .003), as was risk-adjusted long-term mortality (hazard ratio, 0.78; 95% confidence interval, 0.61-1.01).

CONCLUSIONS: In the VA Health System, mortality after MV operations is low. Despite the survival advantage associated with MV repair in primary mitral regurgitation, repair is infrequent at some centers, representing an opportunity for quality improvement.

Author List

Bakaeen FG, Shroyer AL, Zenati MA, Badhwar V, Thourani VH, Gammie JS, Suri RM, Sabik JF 3rd, Gillinov AM, Chu D, Omer S, Hawn MT, Almassi GH, Cornwell LD, Grover FL, Rosengart TK, Graham L

Author

G Hossein Almassi MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Comorbidity
Female
Heart Valve Prosthesis Implantation
Humans
Male
Middle Aged
Mitral Valve
Mitral Valve Annuloplasty
Mitral Valve Insufficiency
Mortality
Postoperative Complications
Quality Improvement
Risk Factors
United States
United States Department of Veterans Affairs
Veterans
Veterans Health