1. Washington Hospital Center
The Outcome of Patients Undergoing Isolated Mitral Valve Surgery as a Potential Comparator for Patients Undergoing Percutaneous Mitral Valve Repair
Sa’ar Minha, Xiumei Sun, Paul Corso, Louis T. Kanda, Bafi S. Ammar, Israel M. Barbash, Danny Dvir, Itsik Ben-Dor, Salem Badr, Joshua P. Loh, Lakshmana K Pendyala, Hironori Kitabata, Rebecca Torguson, Fang Chen, William O. Suddath, Lowell F. Satler, Kenneth M. Kent, Augusto D. Pichard, Ron Waksman
Washington Hospital Center

2. I have no real or apparent conflicts of interest to report.
Sa'ar Minha, MD
I have no real or apparent conflicts of interest to report.

3. Mitral Regurgitation Malcoaptation of mitral valve leaflets.
Incidence of 7-9% of the population ≥75 years of age.
Leading cause for valve surgery in Europe.
Classification:
Primary (degenerative)
Secondary (functional)
Bonow ; JACC 2008;52:e1-e142

4. Edge to Edge Mitral Valve Repair
MitraClip, Abbot Vascular, Santa Clara, CA, USA
Alfieri. J Card Surgery. 2010

5. Everest II
Prospective randomized trial

7. Results
Efficacy
Primary Efficacy Endpoint
Freedom from Death/Surgery for MV dysfunction/MR +3/+4
73% (surgery) vs. 55% (MitraClip);p=0.007)
Cross over of MitaClip to surgery-21%
The exact population of patients to benefit from percutaneous mitral valve repair (PMVR) is unknown.

8. Aim
To study the contemporary operative risk for patients undergoing isolated mitral valve surgery to serve as reference to future PMVR trials.

9. Methods
Retrospective analysis of WHC’s Cardiac Surgery Division data including patient who had an isolated MV replacement/repair between d/t severe MR.
Exclusion criteria
Endocarditis, Prior CABG/Valve surgery.
Comparison Between 3 risk strata according to STS score (STS<3;3≤STS<6;STS ≥ 6).

10. End-Points Incidence of major clinical outcome indices at 30 days:
Operative mortality
Reoperation for failed mitral valve surgery
Stroke
Renal failure
Prolonged ventilation >48 hours
New-onset atrial fibrillation,
Blood product transfusion
Re-admission.

11. Results A total of 422 patient met the inclusion/exclusion criteria.
Repair vs. Replacement
MV Repair 73%
MV replacement 27%.

12. Baseline Characteristics
STS Score<3
(n=350)
STS Score3 to <6
(n=36)
STS Score≥6 P
Age
54.7±12.2
66.3±16.3
70.9±10.5
<0.01
Female gender
140 (40%)
23 (63.9%)
26 (72%)
<0.001
Diabetes
26 (7.4%)
12 (33.3%)
Hypertension
180 (51.4%)
28 (77.8%)
32 (88.9%)
Dyslipidemia
124 (35.4%)
18 (50%)
19 (52.8%)
0.034
Renal failure-dialysis
1 (0.3%)
3 (8.3%)
8 (22.2%)
Peripheral Vascular Disease
9 (2.6%)
1 (2.8%)
5 (13.9%)
0.0003
Preoperative stroke
11 (3.1%)
2 (5.6%)
4 (11.1%)
0.015
Preoperative myocardial infarction
16 (4.6%)
7 (19.4%)
9 (25%)
Heart failure
82 (23.4%)
27 (75%)
29 (80.6%)
Ejection Fraction
52.1±9.9
48±12.3
44.2±13
0.005
New York Heart Association class III-IV
93 (26.6%)
24 (66.8%)
Carcinogenic shock
2 (0.6%)
Preoperative ventricular fibrillation
4 (1.1%)
0.579
Preoperative atrial fibrillation
35 (10%)
14 (38.9%)
Society of Thoracic Surgeons score
0.8±0.7
4±0.8
11.9±6.7

13. Surgical Data STS<3 (n=350) STS Score3 to <6 (n=36) STS≥6 (n=36)
STS<3 (n=350)
STS Score3 to <6
(n=36)
STS≥6 (n=36) P
Mitral Valve Relacement
69 (19.7%)
21 (58.3%
24 (66.7%)
<0.001
Elective Surgery
297 (84.5%)
20 (55.6%)
6 (16.7%)
Perfusion time (min)
97.5±37.7
94±16.3
82.9±31.8
0.074
Cross-clamp time (min)
75.4±30.2
69.4±34.2
59.4±20.5
0.008
Intraoperative IABP
2 (0.6%)
3 (8.3%)
2 (5.6%)

14. %

15. %
P=0.652

16. Discussion
Concordance generally existed between the predicted STS outcome model and the actual results from out cohort.
Sub-analysis of EVEREST II
78 high risk pts. (STS 14.2) who underwent PMVR
Mortality rate of
In the present analysis in the high STS group, mortality rate was (!)
Tamburino; Eur Heart J 2010;31:

17. Limitations Relatively small cohort.
No differentiation between replacement and repair of MV.
No differentiation between functional and degenerative MR.

18. Conclusions
Isolated Mitral valve surgeries are generally performed in patients with low STS scores.
Patients with a STS score >6 are at high risk for mortality and should be subjected to a PMVR.
The STS score should be used as a comparator tool to evaluate the performance of PMVR for patients with severe MR.