Mitral valve repair in a regional quality collaborative: Respect or resect?Central MessagePerspective
Objective: Mitral valve repair is the gold standard for treatment of mitral regurgitation, but the optimal technique remains debated. By using a regional collaborative, we sought to determine the change in repair technique over time. Methods: We identified all patients undergoing isolated mitral val...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250724000063 |
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| author | Alex M. Wisniewski, MD Grant N. Sutherland, BS Raymond J. Strobel, MD, MSc Andrew Young, MD Anthony V. Norman, MD Mohammed Quader, MD Kenan W. Yount, MD Nicholas R. Teman, MD |
| author_facet | Alex M. Wisniewski, MD Grant N. Sutherland, BS Raymond J. Strobel, MD, MSc Andrew Young, MD Anthony V. Norman, MD Mohammed Quader, MD Kenan W. Yount, MD Nicholas R. Teman, MD |
| author_sort | Alex M. Wisniewski, MD |
| collection | DOAJ |
| description | Objective: Mitral valve repair is the gold standard for treatment of mitral regurgitation, but the optimal technique remains debated. By using a regional collaborative, we sought to determine the change in repair technique over time. Methods: We identified all patients undergoing isolated mitral valve repair from 2012 to 2022 for degenerative mitral disease. Those with endocarditis, transcatheter repair, or tricuspid intervention were excluded. Continuous variables were analyzed via Wilcoxon rank sum, and categorical variables were analyzed via chi-square testing. Results: We identified 1653 patients who underwent mitral valve repair, with 875 (59.2%) undergoing a no resection repair. Over the last decade, there was no significant trend in the proportion of repair techniques across the region (P = .96). Those undergoing no resection repairs were more likely to have undergone prior cardiac surgery (5.0% vs 2.2%, P = .002) or minimally invasive approaches (61.4% vs 24.7%, P < .001) with similar predicted risk of mortality (median 0.6% vs 0.6%, P = .75). Intraoperatively, no resection repairs were associated with longer bypass times (140 [117-167] minutes vs 122 [91-159] minutes, P < .001). Operative mortality was similar between both groups (1.1% vs 1.0%, P = .82), as were other postoperative outcomes. Anterior leaflet prolapse (odds ratio, 11.16 [6.34-19.65], P < .001) and minimally invasive approach (odds ratio, 6.40 [5.06-8.10], P < .001) were most predictive of no resection repair. Conclusions: Despite minor differences in operative times, statewide over the past decade there remains a diverse mix of both classic “resect” and newer “respect” strategies with comparable short-term outcomes and no major timewise trends. These data may suggest that both approaches are equivocal. |
| format | Article |
| id | doaj-art-7bd0f777dbf7484ea2c9a7c4b43ab061 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-7bd0f777dbf7484ea2c9a7c4b43ab0612025-08-20T03:36:38ZengElsevierJTCVS Techniques2666-25072024-04-0124667510.1016/j.xjtc.2024.01.004Mitral valve repair in a regional quality collaborative: Respect or resect?Central MessagePerspectiveAlex M. Wisniewski, MD0Grant N. Sutherland, BS1Raymond J. Strobel, MD, MSc2Andrew Young, MD3Anthony V. Norman, MD4Mohammed Quader, MD5Kenan W. Yount, MD6Nicholas R. Teman, MD7Division of Cardiac Surgery, University of Virginia, Charlottesville, VaDivision of Cardiac Surgery, University of Virginia, Charlottesville, VaDivision of Cardiac Surgery, University of Virginia, Charlottesville, VaDivision of Cardiac Surgery, University of Virginia, Charlottesville, VaDivision of Cardiac Surgery, University of Virginia, Charlottesville, VaDivision of Thoracic and Cardiovascular Surgery, Virginia Commonwealth University, Richmond, VaDivision of Cardiac Surgery, University of Virginia, Charlottesville, VaDivision of Cardiac Surgery, University of Virginia, Charlottesville, Va; Address for reprints: Nicholas R. Teman, MD, Department of Surgery, University of Virginia, PO Box 800679, 1215 Lee St, Charlottesville, VA 22908.Objective: Mitral valve repair is the gold standard for treatment of mitral regurgitation, but the optimal technique remains debated. By using a regional collaborative, we sought to determine the change in repair technique over time. Methods: We identified all patients undergoing isolated mitral valve repair from 2012 to 2022 for degenerative mitral disease. Those with endocarditis, transcatheter repair, or tricuspid intervention were excluded. Continuous variables were analyzed via Wilcoxon rank sum, and categorical variables were analyzed via chi-square testing. Results: We identified 1653 patients who underwent mitral valve repair, with 875 (59.2%) undergoing a no resection repair. Over the last decade, there was no significant trend in the proportion of repair techniques across the region (P = .96). Those undergoing no resection repairs were more likely to have undergone prior cardiac surgery (5.0% vs 2.2%, P = .002) or minimally invasive approaches (61.4% vs 24.7%, P < .001) with similar predicted risk of mortality (median 0.6% vs 0.6%, P = .75). Intraoperatively, no resection repairs were associated with longer bypass times (140 [117-167] minutes vs 122 [91-159] minutes, P < .001). Operative mortality was similar between both groups (1.1% vs 1.0%, P = .82), as were other postoperative outcomes. Anterior leaflet prolapse (odds ratio, 11.16 [6.34-19.65], P < .001) and minimally invasive approach (odds ratio, 6.40 [5.06-8.10], P < .001) were most predictive of no resection repair. Conclusions: Despite minor differences in operative times, statewide over the past decade there remains a diverse mix of both classic “resect” and newer “respect” strategies with comparable short-term outcomes and no major timewise trends. These data may suggest that both approaches are equivocal.http://www.sciencedirect.com/science/article/pii/S2666250724000063leaflet preservingleaflet resectionmitral repair techniques |
| spellingShingle | Alex M. Wisniewski, MD Grant N. Sutherland, BS Raymond J. Strobel, MD, MSc Andrew Young, MD Anthony V. Norman, MD Mohammed Quader, MD Kenan W. Yount, MD Nicholas R. Teman, MD Mitral valve repair in a regional quality collaborative: Respect or resect?Central MessagePerspective JTCVS Techniques leaflet preserving leaflet resection mitral repair techniques |
| title | Mitral valve repair in a regional quality collaborative: Respect or resect?Central MessagePerspective |
| title_full | Mitral valve repair in a regional quality collaborative: Respect or resect?Central MessagePerspective |
| title_fullStr | Mitral valve repair in a regional quality collaborative: Respect or resect?Central MessagePerspective |
| title_full_unstemmed | Mitral valve repair in a regional quality collaborative: Respect or resect?Central MessagePerspective |
| title_short | Mitral valve repair in a regional quality collaborative: Respect or resect?Central MessagePerspective |
| title_sort | mitral valve repair in a regional quality collaborative respect or resect central messageperspective |
| topic | leaflet preserving leaflet resection mitral repair techniques |
| url | http://www.sciencedirect.com/science/article/pii/S2666250724000063 |
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