Textbook Outcome in Mitral Valve Surgery-Results from the Netherlands Heart Registration

Historically, surgical results have been evaluated based on morbidity and mortality end-points. Still, patient expectations are centred around the absence of any important complications. Recently, textbook outcome (TO) has been introduced to represent such a result. The main objective of this study is to evaluate TO in mitral valve (MV) surgery and identify factors associated with (non-)TO.

All patients undergoing primary elective MV surgery (± tricuspid valve [TV] surgery, atrial septum defect closure, rhythm surgery) in the Netherlands between 2013 and 2021 were included from the Netherlands Heart Registration. The primary end-point was MV surgery-specific TO, which was defined as absence of respiratory insufficiency, prolonged intubation, readmission to intensive care unit (ICU), postoperative stroke, renal failure, major vascular complications, mediastinitis, and reintervention for bleeding, while also being alive at 1 year, without a reintervention at 1 year.

A total of 3026 patients were included. Mean age was 64.7 ± 11.6 years. TO was achieved in 87.1% of patients (n = 2637). Factors independently associated with non-TO were: age (OR = 1.03, 95% CI, 1.01-1.03 P = .01), reduced left ventricular ejection fraction (<50%) (OR = 1.33, 95% CI, 1.02-1.72 P = .03), pulmonary hypertension (OR = 1.30, 95% CI, 1.00-1.68 P = .05), recent myocardial infarction (OR = 4.71, 95% CI, 1.79-12.38 P = .01), mitral valve replacement (OR = 1.89, 95% CI, 1.48-2.41 P < .01), sternotomy approach (OR = 1.30, 95% CI, 1.02-1.66), and rhythm surgery (OR = 1.33, 95% CI, 1.03-1.71, P = .03).

TO is a clinically relevant measure which can serve as a benchmark to evaluate surgical performance. Future studies may focus on the validation of these results and its application to other procedures.