Simple versus complex degenerative mitral valve disease

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Presentation transcript:

Simple versus complex degenerative mitral valve disease Hoda Javadikasgari, MD, Tomislav Mihaljevic, MD, Rakesh M. Suri, MD, DPhil, Lars G. Svensson, MD, PhD, Jose L. Navia, MD, Robert Z. Wang, MD, Bassman Tappuni, MD, Ashley M. Lowry, MS, Kenneth R. McCurry, MD, Eugene H. Blackstone, MD, Milind Y. Desai, MD, Stephanie L. Mick, MD, A. Marc Gillinov, MD The Journal of Thoracic and Cardiovascular Surgery Volume 156, Issue 1, Pages 122-129.e16 (July 2018) DOI: 10.1016/j.jtcvs.2018.02.102 Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Temporal trends among patients undergoing mitral valve repair. A, Left ventricular (LV) end-systolic volume index. Solid line is a smoothing spline curve and filled circles represent the mean baseline LV end-systolic volume index each year. B, LV mass index. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Temporal trend in New York Heart Association (NYHA) functional class among patients presenting for mitral valve repair. Solid line is a smoothing spline curve and symbols represent the mean percentage of patients with NYHA data available each year. A, All patients. B, Patients with simple disease. C, Patients with complex disease. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Temporal trend of severe postoperative mitral regurgitation (MR) after mitral valve repair in propensity-matched patients. Solid lines represent ensemble average of percentage of patients with severe postoperative MR. Symbols represent data grouped (without regard to repeated measurements) within time frames to provide a crude verification of model fit. Blue line indicates matched simple prolapse group and red line indicates matched complex prolapse group. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Mortality after mitral valve repair in propensity-matched patients. Each symbol represents a death positioned on the vertical axis by the Kaplan-Meier estimator; vertical bars are 68% confidence limits equivalent to ± 1 standard error. Solid lines are parametric hazard estimates enclosed within a dashed 68% confidence band. Blue lines and circles indicate simple prolapse group and red lines and circles indicate complex prolapse group. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Temporal trend of mitral valve repair for all patients with isolated degenerative disease. Solid line is a smoothing spline curve, and filled circles represent percentage of patients with a mitral valve repair each year. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Temporal trend of mitral valve repair. Solid line is a smoothing spline curve, and filled circles represent mean percentage of patients with a mitral valve repair each year. A, Patients with simple disease. B, Patients with complex disease. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Number of propensity-matched patients with mitral regurgitation (MR) records available at and beyond various time points, and number of MR records available for analysis. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Number of patients with postoperative echocardiograms at monthly intervals. Note yearly increases in frequency of echocardiographic measurements, typical of regularly scheduled follow-up examinations. A, Entire cohort. B, Propensity-matched cohort. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E5 Goodness of follow-up over the study period. Patients are represented by blue circles. Nearly solid diagonal line represents those last updated at last systematic anniversary-type follow-up at 2 and 5 years and at 5-year increments to 20 years. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E6 Quality of propensity matching of patients undergoing simple versus complex mitral valve repair. A, Mirrored histogram of distribution of propensity scores for simple and complex groups. Shaded areas represent 2065 matched patient pairs. Unshaded areas represent unmatched patients. B, Standardized difference of selected variables before and after matching, illustrating good matching. BMI, Body mass index; MR, mitral regurgitation; EF, ejection fraction; AFib, atrial fibrillation; STD, standardized. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E7 Temporal trend of complex mitral valve prolapse. Solid line is a smoothing spline curve, and filled circles represent percentage of patients with complex prolapse disease each year. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E8 Temporal trend in left ventricle (LV) end-systolic volume index among patients presenting with simple and complex mitral valve prolapse. Solid line is a smoothing spline curve, and filled circles represent mean values each year. A, Patients with simple disease. B, Patients with complex disease. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E9 Temporal trend in left ventricular mass index among patients presenting with simple and complex mitral valve prolapse. Solid line is a smoothing spline curve, and filled circles represent mean values each year. A, Patients with simple disease. B, Patients with complex disease. LV, Left ventricular. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E10 Temporal trend of severe postoperative mitral regurgitation (MR) after mitral valve repair in propensity-matched patients. Solid lines represent parametric ensemble average of percentage of patients with severe postoperative MR. Symbols represent data grouped (without regard to repeated measurements) within time frames to provide a crude verification of model fit. No/trace MR is denoted by blue line and circles, mild MR is denoted by green line and triangles, moderate MR is denoted by orange line and squares, and severe MR is denoted by red line and diamonds. A, Matched patients with simple disease. B, Matched patients with complex disease. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E11 Temporal trend of severe postoperative mitral regurgitation (MR) after mitral valve repair. Solid lines represent parametric ensemble average of percent of patients with severe postoperative MR. These nomograms are based on the multivariable equation in Table E8. Variables held constant are race other than black, no prior myocardial infarction, preoperative unscaled left atrial volume indexed by body surface area 29 mL/m, preoperative creatinine clearance (Cockcroft-Gault) 93 mL/min, preoperative right ventricular systolic pressure 40 mm Hg, and date of operation January 2005. A, Patients with simple disease. Preoperative right ventricular systolic pressure 40 mm Hg, and date of operation January 2005. B, Patients with complex disease. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E12 Reoperation after mitral valve repair in propensity-matched patients. Each symbol represents a reoperation positioned on the vertical axis by the Kaplan-Meier estimator; vertical bars are 68% confidence limits equivalent to ±1 standard error. Solid lines are parametric hazard estimates enclosed within a dashed 68% confidence band. Simple prolapse group is denoted by blue lines and circles and complex prolapse group is denoted by red lines and circles. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Figure E13 Reoperation after mitral valve repair. Solid lines are parametric hazard estimates. These nomograms are based on the multivariable equation in Table E9. Variables held constant are New York Heart Association functional class II, no prior myocardial infarction, no preoperative pulmonary valve regurgitation, preoperative unscaled left atrial volume indexed by body surface area 29 mL/m, preoperative blood urea nitrogen 18 mg/dL, preoperative creatinine clearance (Cockcroft-Gault) 93 mL/min, preoperative hematocrit 41%, annuloplasty, and date of operation January 2005. A, Patients with simple disease. B, Patients with complex disease. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Temporal trend of severe postoperative mitral regurgitation (MR) after mitral valve repair. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Simple versus complex degenerative mitral valve disease. Video available at: https://www.jtcvs.org/article/S0022-5223(18)30896-1/fulltext. The Journal of Thoracic and Cardiovascular Surgery 2018 156, 122-129.e16DOI: (10.1016/j.jtcvs.2018.02.102) Copyright © 2018 The American Association for Thoracic Surgery Terms and Conditions