Towards an integrated approach to mitral valve disease: implementation of an interventional mitral valve programme and its impact on surgical activity
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Towards an integrated approach to mitral valve disease: implementation of an interventional mitral valve programme and its impact on surgical activity. / Conradi, Lenard; Seiffert, Moritz; Treede, Hendrik; Rudolph, Volker; Silaschi, Miriam; Blankenberg, Stefan; Baldus, Stephan; Reichenspurner, Hermann.
In: EUR J CARDIO-THORAC, Vol. 44, No. 2, 08.2013, p. 324-328.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Towards an integrated approach to mitral valve disease: implementation of an interventional mitral valve programme and its impact on surgical activity
AU - Conradi, Lenard
AU - Seiffert, Moritz
AU - Treede, Hendrik
AU - Rudolph, Volker
AU - Silaschi, Miriam
AU - Blankenberg, Stefan
AU - Baldus, Stephan
AU - Reichenspurner, Hermann
PY - 2013/8
Y1 - 2013/8
N2 - OBJECTIVES: Transcatheter-based treatment of valvular heart disease has increasingly been implemented for the treatment of high-risk patients. The impact of these new treatment modalities on surgical valve programmes is unclear at present. We sought to evaluate the impact of an interventional mitral valve programme on surgical mitral valve activity and to assess the risk profiles of the respective patient populations.METHODS: Between 2007 and 2011, 1112 patients underwent mitral valve surgery for isolated or combined procedures. An interventional mitral valve programme was initiated in 2008, with 270 patients treated from 2008 to 2011. Data were prospectively entered into a database and retrospectively analysed.RESULTS: From 2007 to 2011, surgical mitral valve activity increased by 29.9% compared with a 9.8% increase nationwide (P = 0.09). Compared with the year before the introduction of a MitraClip programme, mean logistic EuroSCORE I of surgical patients was similar in 2011 (2007: 9.4 ± 10.4 vs 2011: 9.5 ± 10.5; P = 0.92), while overall 30-day mortality decreased from 7.2 to 4.4% (P = 0.22). The risk profile of surgical patients decreased significantly regarding several parameters. For isolated mitral valve repair, 30-day mortality was 1.5% (6 of 406) in all patients during the study period. Mean logistic EuroSCORE I of transcatheter patients was significantly higher when compared with that of surgical patients (28.8 ± 18.8 vs 9.5 ± 10.5%; P < 0.01).CONCLUSIONS: Since the implementation of an interventional mitral valve programme, surgical mitral valve activity has increased over the following years. The risk profile of surgical patients decreased regarding several important parameters, although the overall logistic EuroSCORE I remained unchanged. An integrated approach to mitral valve disease with complementary surgical and non-surgical treatment options may possibly help in relieving the undertreatment of patients with severe mitral regurgitation.
AB - OBJECTIVES: Transcatheter-based treatment of valvular heart disease has increasingly been implemented for the treatment of high-risk patients. The impact of these new treatment modalities on surgical valve programmes is unclear at present. We sought to evaluate the impact of an interventional mitral valve programme on surgical mitral valve activity and to assess the risk profiles of the respective patient populations.METHODS: Between 2007 and 2011, 1112 patients underwent mitral valve surgery for isolated or combined procedures. An interventional mitral valve programme was initiated in 2008, with 270 patients treated from 2008 to 2011. Data were prospectively entered into a database and retrospectively analysed.RESULTS: From 2007 to 2011, surgical mitral valve activity increased by 29.9% compared with a 9.8% increase nationwide (P = 0.09). Compared with the year before the introduction of a MitraClip programme, mean logistic EuroSCORE I of surgical patients was similar in 2011 (2007: 9.4 ± 10.4 vs 2011: 9.5 ± 10.5; P = 0.92), while overall 30-day mortality decreased from 7.2 to 4.4% (P = 0.22). The risk profile of surgical patients decreased significantly regarding several parameters. For isolated mitral valve repair, 30-day mortality was 1.5% (6 of 406) in all patients during the study period. Mean logistic EuroSCORE I of transcatheter patients was significantly higher when compared with that of surgical patients (28.8 ± 18.8 vs 9.5 ± 10.5%; P < 0.01).CONCLUSIONS: Since the implementation of an interventional mitral valve programme, surgical mitral valve activity has increased over the following years. The risk profile of surgical patients decreased regarding several important parameters, although the overall logistic EuroSCORE I remained unchanged. An integrated approach to mitral valve disease with complementary surgical and non-surgical treatment options may possibly help in relieving the undertreatment of patients with severe mitral regurgitation.
KW - Aged
KW - Female
KW - Heart Valve Prosthesis Implantation/instrumentation
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Mitral Valve/surgery
KW - Mitral Valve Insufficiency/surgery
KW - Retrospective Studies
KW - Risk Factors
KW - Treatment Outcome
U2 - 10.1093/ejcts/ezs704
DO - 10.1093/ejcts/ezs704
M3 - SCORING: Journal article
C2 - 23355691
VL - 44
SP - 324
EP - 328
JO - EUR J CARDIO-THORAC
JF - EUR J CARDIO-THORAC
SN - 1010-7940
IS - 2
ER -
