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A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Mitral valvular surgery outcomes in a centre with a dedicated mitral multi-disciplinary team
Ishtiaq Rahman1, Cristina Ruiz Segria2, Jason Trevis3
1Post-CCT Fellow in Cardiothoracic Surgery.
The British Journal of Cardiology
|September 26, 2024
Summary
A dedicated mitral multi-disciplinary team (MDT) improves outcomes for mitral valvular surgery patients. This approach ensures high mitral valve repair rates and excellent patient results, enhancing safe care delivery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Decision Making
Background:
- International guidelines advocate for 'heart teams' in surgical decision-making.
- Significant variations exist in heart team composition and protocols across institutions.
- Dedicated multi-disciplinary teams (MDTs) may optimize mitral valvular surgery outcomes.
Purpose of the Study:
- To assess the impact of a dedicated mitral MDT on patient outcomes.
- To evaluate the effectiveness of a structured MDT process in a tertiary referral center.
- To analyze surgical outcomes, including repair rates and mortality, for mitral valvular disease.
Main Methods:
- Retrospective review of prospectively collected data from a dedicated 'mitral database'.
- Inclusion of pre-operative imaging, clinical data, and mandatory transoesophageal echocardiography in MDT discussions.
- Analysis of surgical outcomes for patients discussed at MDT versus those who underwent surgery without MDT review.
Main Results:
- 395 patients discussed at MDT; 310 underwent surgery between 2016-2020.
- Elective degenerative mitral regurgitation (DMR) surgery via MDT showed a 93% repair rate, 2% mortality, and 5-day median length of stay.
- Postoperative echocardiography confirmed excellent results for DMR patients (≤2+ MR in 99%).
- Urgent/emergent cases (75 patients) often involved DMR or infective endocarditis without prior MDT discussion.
Conclusions:
- A dedicated mitral MDT enhances the safe delivery of care for mitral valvular disease.
- This structured approach leads to consistently high mitral valve repair rates, particularly for DMR.
- Excellent patient outcomes, including low mortality and morbidity, are achievable with a specialized mitral MDT.
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