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Impact of Complex Anatomy and Patient Risk Profile in Minimally Invasive Mitral Valve Surgery.
Paolo Berretta1, Antonios Pitsis2, Nikolaos Bonaros3
1Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy.
The Annals of Thoracic Surgery
|September 1, 2024
Summary
Minimally invasive techniques effectively treat complex mitral valve disease, though anterior leaflet lesions and bileaflet flail impact repair success. High-risk patients face poorer outcomes regardless of disease complexity.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Minimally Invasive Cardiac Surgery
Background:
- Assessing outcomes of complex mitral valve disease and patient risk in a large international registry.
- Analyzing degenerative mitral valve regurgitation (DMR) based on valve anatomy and patient risk profiles.
Purpose of the Study:
- To evaluate the impact of complex mitral valve disease and patient risk on operative outcomes.
- To identify predictors of valve repair success and operative risk in DMR patients.
Main Methods:
- Categorized 4524 DMR patients into complex (bileaflet or anterior leaflet prolapse/flail) and simple (posterior leaflet prolapse/flail) groups.
- Performed subgroup analyses for low-risk (EuroSCORE II <8%) and high-risk (EuroSCORE II >8%) patients.
- Utilized logistic regression to analyze valve anatomy and patient risk factors' influence on repair rates and operative risk.
Main Results:
- Overall valve repair rates were 87.3% for complex DMR and 91% for simple DMR.
- Anterior leaflet prolapse/flail, bileaflet flail, female sex, age, and reoperation predicted valve replacement; Barlow disease was protective.
- High-risk patients had less satisfactory outcomes regarding valve repair and operative mortality.
Conclusions:
- Complex DMR can be effectively treated with minimally invasive approaches, with low operative risk.
- Anterior leaflet lesions and bileaflet flail are negative predictors for successful valve repair.
- Valve repair outcomes were less satisfactory in high-risk patients, irrespective of DMR complexity.
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