TY - JOUR
T1 - Increasing disadvantage of "watchful waiting" for repairing degenerative mitral valve disease
AU - Yazdchi, Farhang
AU - Koch, Colleen G.
AU - Mihaljevic, Tomislav
AU - Hachamovitch, Rory
AU - Lowry, Ashley M.
AU - He, Jiayan
AU - Gillinov, A. Marc
AU - Blackstone, Eugene H.
AU - Sabik, Joseph F.
N1 - Funding Information:
This study was funded in part by the Sheikh Hamdan bin Rashid Al Maktoum Distinguished Chair in Thoracic and Cardiovascular Surgery (held by Dr Sabik), and the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (held by Dr Blackstone). Farhang Yazdchi, MD, MS, was a National Heart, Lung and Blood Institute Clinical Research Scholar of the Cardiothoracic Surgical Trials Network, and his master of science in clinical research was funded by National Institutes of Health grant 1U01HL088955 .
Publisher Copyright:
© 2015 The Society of Thoracic Surgeons.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Background Successful durable repair of severe degenerative mitral regurgitation with low operative mortality encourages intervention in asymptomatic patients rather than "watchful waiting." Our objectives were to assess trends in patient characteristics, timing of intervention, and evolving surgical techniques at a high-volume center, and determine effects of these changes on outcomes after mitral valve (MV) repair over a 25-year period. Methods From January 1, 1985, to January 1, 2011, 5,902 patients underwent isolated repair (with or without tricuspid repair for functional regurgitation) for degenerative MV disease at Cleveland Clinic. For illustration, the experience is presented in 3 eras: 1985 to 1997 (era 1, n = 1,184), 1997 to 2005 (era 2, n = 2,400), and 2005 to 2011 (era 3, n = 2,318). Results In era 3, more patients were asymptomatic on presentation (44% in New York Heart Association [NYHA] class I vs 25% in era 1), with less heart failure (11% vs 29%) and atrial fibrillation (9.9% vs 23%). Full sternotomy decreased from era 1 (n = 1,100/93%) to era 2 (n = 602/25%) (era 3, n = 717/31%), and robotic surgery emerged (n = 577/25%) in era 3. Median length of stay shortened (era 1 = 7 days, era 2 = 5.9 days, era 3 = 5.2 days, p < 0.0001), and in-hospital mortality remained low (era 1 = 5/0.42%, era 2 = 5/0.21%, era 3 = 1/0.043%); 0.73% overall required reoperation on the repaired valve before discharge, and 97% had 0 to 1+ regurgitation at discharge. Conclusions Treatment trends over 25 years reveal that rather than watchful waiting, a more aggressive approach to degenerative MV disease, with earlier intervention for severe regurgitation in asymptomatic patients and less invasive operative techniques, is successful, safe, and effective.
AB - Background Successful durable repair of severe degenerative mitral regurgitation with low operative mortality encourages intervention in asymptomatic patients rather than "watchful waiting." Our objectives were to assess trends in patient characteristics, timing of intervention, and evolving surgical techniques at a high-volume center, and determine effects of these changes on outcomes after mitral valve (MV) repair over a 25-year period. Methods From January 1, 1985, to January 1, 2011, 5,902 patients underwent isolated repair (with or without tricuspid repair for functional regurgitation) for degenerative MV disease at Cleveland Clinic. For illustration, the experience is presented in 3 eras: 1985 to 1997 (era 1, n = 1,184), 1997 to 2005 (era 2, n = 2,400), and 2005 to 2011 (era 3, n = 2,318). Results In era 3, more patients were asymptomatic on presentation (44% in New York Heart Association [NYHA] class I vs 25% in era 1), with less heart failure (11% vs 29%) and atrial fibrillation (9.9% vs 23%). Full sternotomy decreased from era 1 (n = 1,100/93%) to era 2 (n = 602/25%) (era 3, n = 717/31%), and robotic surgery emerged (n = 577/25%) in era 3. Median length of stay shortened (era 1 = 7 days, era 2 = 5.9 days, era 3 = 5.2 days, p < 0.0001), and in-hospital mortality remained low (era 1 = 5/0.42%, era 2 = 5/0.21%, era 3 = 1/0.043%); 0.73% overall required reoperation on the repaired valve before discharge, and 97% had 0 to 1+ regurgitation at discharge. Conclusions Treatment trends over 25 years reveal that rather than watchful waiting, a more aggressive approach to degenerative MV disease, with earlier intervention for severe regurgitation in asymptomatic patients and less invasive operative techniques, is successful, safe, and effective.
UR - http://www.scopus.com/inward/record.url?scp=84930929206&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84930929206&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2015.01.065
DO - 10.1016/j.athoracsur.2015.01.065
M3 - Article
C2 - 25916875
AN - SCOPUS:84930929206
SN - 0003-4975
VL - 99
SP - 1992
EP - 2000
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -