Concomitant interventions in mitral valve surgery - A European perspective.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Interventional Cardiology

Background:

• Recent advancements in concomitant procedures and anticoagulation management have significantly impacted Mitral Valve (MV) surgery.
• Existing literature indicates a need to assess current European practices in MV interventions.
• Understanding contemporary surgical strategies is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate current practices in Mitral Valve (MV) interventions across Europe.
• To identify variations in surgical techniques and anticoagulation management.
• To compare current practices with established clinical guidelines.

Main Methods:

• An online survey comprising 14 questions was distributed to consultant/attending cardiac surgeons across Europe in October 2021.
• National cardio-thoracic societies were identified via electronic search to facilitate survey distribution.
• The survey focused on concomitant procedures, surgical decision-making, and anticoagulation strategies for MV surgery.

Main Results:

• 91 surgeons from 12 European countries participated, with 78% specializing in MV repair and most performing over 150 operations annually with extensive experience.
• Significant variability exists in managing concomitant tricuspid regurgitation and performing ischemic MV surgery during CABG, with differing criteria for intervention.
• Practices for atrial fibrillation (AF) management, including ablation and Left Atrial Appendage (LAA) occlusion, and anticoagulation strategies for MV repair and bioprosthetic valves show wide divergence.

Conclusions:

• Current Mitral Valve (MV) surgery practices in Europe are highly variable.
• There appears to be a lack of consistent adherence to established surgical intervention guidelines.
• Anticoagulation strategies also exhibit significant variability, suggesting a need for guideline reinforcement and standardization.