Mitral Valve Repair Rate at a Veterans Affairs Hospital Utilizing a Multidisciplinary Heart Team

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Valvular Heart Disease

Background:

• Mitral valve (MV) repair rates were historically low (21%) at this low-volume Veterans Affairs hospital.
• Degenerative mitral valve disease is a common indication for surgical intervention.

Purpose of the Study:

• To evaluate the impact of a multidisciplinary valve team on MV repair rates and patient outcomes.
• To characterize MV repair outcomes in patients with degenerative mitral valve disease.

Main Methods:

• Retrospective review of 103 MV operations (1/2009–8/2016) after multidisciplinary team implementation.
• Categorization of MV pathology and review of surgical techniques.
• Assessment of leaflet involvement and postoperative function in degenerative disease patients.

Main Results:

• Overall MV repair rate increased to 67% with 0.97% 30-day mortality.
• In degenerative disease patients, 86.5% underwent successful MV repair (no reoperations).
• Sternotomy approach yielded higher repair rates (92.5%) than minimally invasive (71.4%) for degenerative disease (P=0.03).
• Post-repair, 95.3% of degenerative patients had mild or less mitral regurgitation.
• Dystrophic leaflet calcification and severe annular calcification were associated with lower repair rates.

Conclusions:

• A multidisciplinary valve team significantly improved MV repair rates and quality at a low-volume center.
• Successful MV repair is achievable for degenerative disease, with specific anatomical features impacting feasibility.
• Preoperative planning is crucial for optimizing MV repair outcomes in degenerative valve disease.