Use of mitral valve repair: analysis of contemporary United States experience reported to the Society of Thoracic Surgeons National Cardiac Database

Abstract

Background The Society of Thoracic Surgeons National Cardiac Database data indicate that the performance of mitral repair has increased significantly (1990 to 23.2%, 1999 to 32.0%, p < 0.0001). We examined contemporary (1999 to 2000) usage of mitral repair in the United States. Methods We analyzed National Cardiac Database data to determine the operative approach for a diagnosis of mitral regurgitation. Results A total of 21,741 isolated and combined mitral valve procedures were identified. The overall frequency of repair was 37.7% (8206). For procedures isolated to the mitral valve, the frequency of repair was 35.7% (3027/8486) whereas repair was more common with concomitant CABG (42.9% [3088/7193], p < 0.0001). The proportion of patients having repair decreased with age (41.2% [386/936] in 20 to 39 years, 36.1% [3513/9746] in > 70 years, p = 0.0016). Repair was more common in males (43.5% [4720/10860]) than females (32.0% [3472/10842], p < 0.0001). Repair was less common as NYHA Class increased (Class I, 47.8% [949/1984] vs Class IV, 33.2% [1803/5427]) and for emergent operative status (21.2% [156/736] vs 38.5% [8000/20773] for elective/urgent, both p < 0.0001). The number of prior operations did not affect the use of repair. Simple annuloplasty was performed in the majority of reported repairs (62.8% [3837/6115]), more so with associated CABG as compared to isolated repair (70.2% [2167/3088] vs 55.2% [1670/3027]; p < 0.0001). Conclusions Mitral repair was performed in over one-third of the patients reported in 1999 to 2000 and has increased since the National Cardiac Database inception. Repair usage differed based on sex, age, gravity of illness, and associated procedures. This provides a base line from which to expand the application of repair.