Setting Benchmarks for Long-Term Success of Surgical Mitral Valve Repair in Reference Centers

Abstract

Section snippets

Comparing Contemporary and Historical Data

One of the salient findings of this study is the extraordinarily low 30-day mortality rate of 0.48%, which further drops to 0.21% for isolated MV repair cases. Their cohort was predominantly low risk, with EuroSCORE II of 0.9%. The outcomes reported by Del Forno et al⁵ compare favorably to the operative mortality of 1.16% for isolated degenerative mitral repair in the STS ACSD (Society of Thoracic Surgeons Adult Cardiac Surgery Database) analysis.⁶The MIDA (Mitral Regurgitation International

Investigator-Led vs Third-Party Adjudication of Outcomes

Historically, reports of long-term outcomes after surgical mitral repair faced limitations of data sources: 1) representative data sets with vital statistics and hospitalization information, such as claims data sets, lack crucial surgical and anatomical variables; and 2) large clinical registries, like the STS databases, that house relevant variables are limited by the necessary linkage to claims data to generate long-term outcomes such as reoperation and rehospitalizations. STS-Medicare

Implications of the Study

The study provides us with the following. First, the excellent short- and long-term validated outcomes at a reference center show us what might be possible. There remain gaps between outcomes at such centers and registry outcomes that include broader range of center expertise. Initiatives such as the American Heart Association mitral reference center designation could help bridge this gap by promoting centralization of care. In parallel, elevating the overall expertise within the surgical

Conclusions

This contemporary analysis of MV repair outcomes at a historically important reference center provides a new benchmark for evaluating the success of MV repair. The results are based on third-party adjudication, demonstrating excellent survival, freedom from reoperation, and heart failure rehospitalization. Taken together, the study redefines the gold standard of surgical mitral repair.

Funding Support and Author Disclosures

Dr Geirsson has received consultation fees from Medtronic and Edwards Lifesciences. Dr Mori has reported that he has no relationships relevant to the contents of this paper to disclose.