A “Repair-All” Strategy for Degenerative Mitral Valve Disease Safely Minimizes Unnecessary Replacement Andrew B. Goldstone, MD, Jeffrey E. Cohen, MD,

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Presentation transcript:

A “Repair-All” Strategy for Degenerative Mitral Valve Disease Safely Minimizes Unnecessary Replacement Andrew B. Goldstone, MD, Jeffrey E. Cohen, MD, Jessica L. Howard, BS, Bryan B. Edwards, BE, Alexandra L. Acker, BS, William Hiesinger, MD, John W. MacArthur, MD, Pavan Atluri, MD, Y. Joseph Woo, MD The Annals of Thoracic Surgery Volume 99, Issue 6, Pages 1983-1991 (June 2015) DOI: 10.1016/j.athoracsur.2014.12.076 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Flow chart of patients included in the study. All patients with confirmed leaflet prolapse on preoperative echocardiography, severe mitral regurgitation (MR), and without concomitant endocarditis, mitral stenosis, or prior mitral valve operation underwent a “repair-all” strategy. The Annals of Thoracic Surgery 2015 99, 1983-1991DOI: (10.1016/j.athoracsur.2014.12.076) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Actuarial development of moderate mitral regurgitation is shown for (A) the entire study population, (B) the population stratified by type of leaflet prolapse (posterior versus anterior [AL] or bileaflet [BL]) (p = 0.15), (C) the population stratified by whether the index repair was revised (p = 0.07), and (D) the propensity-matched population stratified by operative approach (p = 0.2). Numbers at risk are included within the graph. (B–D) The blue line indicates no (0), and the red line indicates yes (1). The Annals of Thoracic Surgery 2015 99, 1983-1991DOI: (10.1016/j.athoracsur.2014.12.076) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Actuarial development of New York Heart Association functional class III or IV symptoms for (A) the entire study population, (B) the population stratified by leaflet prolapse (posterior versus anterior [AL] or bileaflet [BL]) (p = 0.4), (C) the population stratified by whether the index repair was revised (p = 0.6), and (D) the propensity score-matched population stratified by operative approach (p = 0.4). Numbers at risk are included within the graph. (B–D) The blue line indicates no (0), and the red line indicates yes (1). The Annals of Thoracic Surgery 2015 99, 1983-1991DOI: (10.1016/j.athoracsur.2014.12.076) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Actuarial survival stratified by whether the index repair was revised during the initial operation (p = 0.2). Numbers at risk are included within the graph. The blue line indicates no (0), and the red line indicates yes (1). The Annals of Thoracic Surgery 2015 99, 1983-1991DOI: (10.1016/j.athoracsur.2014.12.076) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions