Bakaeen FG, et al. - Authors performed a comparison of mitral valve repair (MVRepair) and replacement (MVReplace) trends in the Veterans Affairs (VA) Surgical Quality Improvement Program. In this study, a low mortality was observed after MV operations. MV repair seemed associated with the survival advantage in primary mitral regurgitation, but, was infrequent at some centers, representing an opportunity for quality improvement.

Methods

• Comparison of trends was performed by bivariate analyses, this was followed by backward stepwise selection and multivariable logistic modelling to determine the effect of preoperative comorbidities and facility-level factors on MVRepair (vs MVReplace) rate.
• Researchers performed a subgroup analysis that focused on patients who underwent elective surgery for isolated primary degenerative mitral regurgitation.
• In the overall and primary degenerative cohorts, propensity matching was performed.

Results

• At 40 VA medical centers (procedural volume, 0-29/y; median 7/y), 4165 veterans underwent MVRepair (n=2408) or MVReplace (n=1757) for MV disease of any cause from October 2000 to October 2013.
• An increase in the MVRepair percentage from 48% in 2001 to 63% in 2013 (P<0.001) was observed.
• There appeared wide variation regarding MVRepair rates among centers; center volume explained only 19% of this variation after adjustment for case mix (R2=0.19, P=0.005).
• Unadjusted 30-day and 1-year mortality rates after MVRepair were lower than after MVReplace (3.5% vs 4.8%, P=0.04; 9.8% vs 12.1%, P=0.02).
• Among the propensity-matched patients (n=2520), similar 30-day and 1-year mortality was observed 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=0.003), as was risk-adjusted long-term mortality (hazard ratio 0.78, 95% CI 0.61-1.01).