Mitral Valve Repair
Background: Despite strong recommendations from multiple societies to pursue durable mitral valve repair (MVr), repair rates and outcomes remain inconsistent across the world. This is partly due to limited surgeon and center experience and lack of centralization of care for this technically challeng...
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| Language: | English |
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Elsevier
2025-03-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X25000067 |
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| author | Irbaz Hameed, MD Adham Ahmed, BS Christina Waldron, BS Percy T. Algarate, MD Michal Kawczynski, MD Maurish Fatima, MBBS, BS Amnah Alhazmi, MBBS Samantha Colon, BS Alexandria Brackett, MA, MLIS Samuel Heuts, MD, PhD Peyman Sardari Nia, MD, PhD Mario Gaudino, MD, PhD Vinay Badhwar, MD Arnar Geirsson, MD |
| author_facet | Irbaz Hameed, MD Adham Ahmed, BS Christina Waldron, BS Percy T. Algarate, MD Michal Kawczynski, MD Maurish Fatima, MBBS, BS Amnah Alhazmi, MBBS Samantha Colon, BS Alexandria Brackett, MA, MLIS Samuel Heuts, MD, PhD Peyman Sardari Nia, MD, PhD Mario Gaudino, MD, PhD Vinay Badhwar, MD Arnar Geirsson, MD |
| author_sort | Irbaz Hameed, MD |
| collection | DOAJ |
| description | Background: Despite strong recommendations from multiple societies to pursue durable mitral valve repair (MVr), repair rates and outcomes remain inconsistent across the world. This is partly due to limited surgeon and center experience and lack of centralization of care for this technically challenging operation. Objectives: The authors evaluate the association between annual case volume and contemporary long-term outcomes of patients undergoing isolated MVr. Methods: A systematic literature search was performed to identify contemporary studies on isolated MVr in adults from January 2013 to November 2023. The primary outcomes were long-term survival, freedom from reoperation, and freedom from recurrent mitral regurgitation (moderate-severe). A novel meta-analytic volume-outcome approach using reconstructed Kaplan-Meier-derived individual patient data from the original studies was used. A frailty Cox model was applied to study volume-outcome relationships. Studies were pooled for each reported outcome and divided into 3 tertiles (T1-3) based on the annual case volume and number of patients of each center. Results: A total of 14,070 patients from 60 studies were pooled. Sixteen studies (6,099 patients) reported long-term survival. The overall pooled 10-year survival was 70.8% (95% CI: 68.9%-72.8%). Compared to lower volume centers, centers performing >38 cases/y were associated with significantly improved long-term survival (HR: 0.42; 95% CI: 0.36-0.49; P < 0.001). For degenerative mitral valve disease, a volume cutoff of >45 cases/y was associated with significantly improved long-term survival (HR: 0.40; 95% CI: 0.32-0.49; P < 0.001). Twelve studies (4,230 patients) reported long-term freedom from reoperation and 10 studies (2,470 patients) reported Kaplan-Meier-derived long-term freedom from recurrent mitral regurgitation data, respectively. The overall pooled 10-year freedom from reoperation was 90.2% (95% CI: 88.1%-92.4%), while the overall pooled 10-year freedom from recurrent mitral regurgitation was 72.7% (95% CI: 68.9%-76.8%). Centers performing >45 cases/y (HR: 0.61; 95% CI: 0.44-0.84; P = 0.003) and >70 cases/y (HR: 0.64; 95% CI: 0.42-0.98; P = 0.042) were associated with significantly improved long-term freedom from recurrent mitral regurgitation and freedom from reoperation, respectively. For degenerative mitral disease, >45 cases/y was associated with significantly improved freedom from recurrent mitral regurgitation (HR: 0.51; 95% CI: 0.36-0.72; P < 0.001); the volume outcome association for freedom from reoperation was not statistically significant (P = 0.58). Conclusions: Our study validates volume cutoffs associated with optimal long-term outcomes following isolated MVr. We found MVr volumes of >38 cases/y, 45 cases/y, and >70 cases/y to be associated with significantly improved long-term survival, durability of repair, and freedom from reoperation, respectively. These findings may define experienced centers and surgeons for patients requiring MVr for primary/degenerative mitral valve disease. |
| format | Article |
| id | doaj-art-e2f5d2df34894eb088564c1398573e4e |
| institution | Kabale University |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-e2f5d2df34894eb088564c1398573e4e2025-02-11T04:35:43ZengElsevierJACC: Advances2772-963X2025-03-0143101589Mitral Valve RepairIrbaz Hameed, MD0Adham Ahmed, BS1Christina Waldron, BS2Percy T. Algarate, MD3Michal Kawczynski, MD4Maurish Fatima, MBBS, BS5Amnah Alhazmi, MBBS6Samantha Colon, BS7Alexandria Brackett, MA, MLIS8Samuel Heuts, MD, PhD9Peyman Sardari Nia, MD, PhD10Mario Gaudino, MD, PhD11Vinay Badhwar, MD12Arnar Geirsson, MD13Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA; Address for correspondence: Dr Irbaz Hameed, Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, 20 York Street, New Haven, Connecticut 06511, USA.Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USADivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USADivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USADepartment of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the NetherlandsDivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USADivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USADivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USADivision of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USADepartment of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the NetherlandsDepartment of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the NetherlandsDepartment of Cardiothoracic Surgery, New York Presbyterian-Weill Cornell Medicine, New York, New York, USADepartment of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USADivision of Cardiac Surgery, New York Presbyterian-Columbia University School of Medicine, New York, New York, USABackground: Despite strong recommendations from multiple societies to pursue durable mitral valve repair (MVr), repair rates and outcomes remain inconsistent across the world. This is partly due to limited surgeon and center experience and lack of centralization of care for this technically challenging operation. Objectives: The authors evaluate the association between annual case volume and contemporary long-term outcomes of patients undergoing isolated MVr. Methods: A systematic literature search was performed to identify contemporary studies on isolated MVr in adults from January 2013 to November 2023. The primary outcomes were long-term survival, freedom from reoperation, and freedom from recurrent mitral regurgitation (moderate-severe). A novel meta-analytic volume-outcome approach using reconstructed Kaplan-Meier-derived individual patient data from the original studies was used. A frailty Cox model was applied to study volume-outcome relationships. Studies were pooled for each reported outcome and divided into 3 tertiles (T1-3) based on the annual case volume and number of patients of each center. Results: A total of 14,070 patients from 60 studies were pooled. Sixteen studies (6,099 patients) reported long-term survival. The overall pooled 10-year survival was 70.8% (95% CI: 68.9%-72.8%). Compared to lower volume centers, centers performing >38 cases/y were associated with significantly improved long-term survival (HR: 0.42; 95% CI: 0.36-0.49; P < 0.001). For degenerative mitral valve disease, a volume cutoff of >45 cases/y was associated with significantly improved long-term survival (HR: 0.40; 95% CI: 0.32-0.49; P < 0.001). Twelve studies (4,230 patients) reported long-term freedom from reoperation and 10 studies (2,470 patients) reported Kaplan-Meier-derived long-term freedom from recurrent mitral regurgitation data, respectively. The overall pooled 10-year freedom from reoperation was 90.2% (95% CI: 88.1%-92.4%), while the overall pooled 10-year freedom from recurrent mitral regurgitation was 72.7% (95% CI: 68.9%-76.8%). Centers performing >45 cases/y (HR: 0.61; 95% CI: 0.44-0.84; P = 0.003) and >70 cases/y (HR: 0.64; 95% CI: 0.42-0.98; P = 0.042) were associated with significantly improved long-term freedom from recurrent mitral regurgitation and freedom from reoperation, respectively. For degenerative mitral disease, >45 cases/y was associated with significantly improved freedom from recurrent mitral regurgitation (HR: 0.51; 95% CI: 0.36-0.72; P < 0.001); the volume outcome association for freedom from reoperation was not statistically significant (P = 0.58). Conclusions: Our study validates volume cutoffs associated with optimal long-term outcomes following isolated MVr. We found MVr volumes of >38 cases/y, 45 cases/y, and >70 cases/y to be associated with significantly improved long-term survival, durability of repair, and freedom from reoperation, respectively. These findings may define experienced centers and surgeons for patients requiring MVr for primary/degenerative mitral valve disease.http://www.sciencedirect.com/science/article/pii/S2772963X25000067annuloplastymitral valverepairvolume |
| spellingShingle | Irbaz Hameed, MD Adham Ahmed, BS Christina Waldron, BS Percy T. Algarate, MD Michal Kawczynski, MD Maurish Fatima, MBBS, BS Amnah Alhazmi, MBBS Samantha Colon, BS Alexandria Brackett, MA, MLIS Samuel Heuts, MD, PhD Peyman Sardari Nia, MD, PhD Mario Gaudino, MD, PhD Vinay Badhwar, MD Arnar Geirsson, MD Mitral Valve Repair JACC: Advances annuloplasty mitral valve repair volume |
| title | Mitral Valve Repair |
| title_full | Mitral Valve Repair |
| title_fullStr | Mitral Valve Repair |
| title_full_unstemmed | Mitral Valve Repair |
| title_short | Mitral Valve Repair |
| title_sort | mitral valve repair |
| topic | annuloplasty mitral valve repair volume |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X25000067 |
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