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Minimally invasive mitral valve surgery in high-risk patients: operating outside the boxplot
Marco Moscarelli1, Alfredo Cerillo2, Thanos Athanasiou3
1Pasquinucci Hospital, Ospedale del Cuore, Fondazione Monasterio, Massa, Italy NHLI, Imperial College of London, London, UK m.moscarelli@imperial.ac.uk.
Interactive Cardiovascular and Thoracic Surgery
|March 9, 2016
Summary
Minimally invasive mitral surgery shows acceptable outcomes for high-risk patients, defined by EuroSCORE II. Major outliers (≥9%) may benefit more from catheter-based procedures, indicating personalized risk assessment for mitral valve interventions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Technology Assessment
Background:
- Minimally invasive mitral valve surgery is increasingly performed.
- Identifying high-risk patients for mitral surgery is crucial for optimizing outcomes.
- Existing risk scores may not fully capture the nuances of surgical risk.
Purpose of the Study:
- To define high-risk criteria for mitral surgery using EuroSCORE II.
- To evaluate the early and late outcomes of minimally invasive mitral surgery in high-risk patients.
- To compare outcomes between high-risk and non-high-risk populations undergoing minimally invasive mitral surgery.
Main Methods:
- Prospective data from 1873 patients undergoing minimally invasive mitral surgery (2003-2015) were reviewed.
- Boxplot analysis of EuroSCORE II was used to identify 'outliers of risk' as high-risk patients.
- Outcomes, including survival and complications, were compared between risk groups.
Main Results:
- Two hundred and five patients were identified as outliers (minor ≥6% EuroSCORE II, n=98; major ≥9% EuroSCORE II, n=107).
- In-hospital mortality was 9.2% among outliers, with significantly lower survival and higher cardiac-related death risk compared to the general population.
- Major outliers experienced the worst outcomes, though mitral reintervention rates and regurgitation severity were similar across groups.
Conclusions:
- Boxplot analysis of EuroSCORE II (≥6%) effectively identified high-risk patients for mitral surgery.
- Minimally invasive mitral surgery yielded acceptable early and long-term results in these high-risk patients.
- Major outliers (≥9% EuroSCORE II) might achieve better results with catheter-based interventions, suggesting tailored treatment approaches.
