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Farhang Yazdchi, MD, MS, Colleen G

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1 Increasing Disadvantage of “Watchful Waiting” for Repairing Degenerative Mitral Valve Disease 
Farhang Yazdchi, MD, MS, Colleen G. Koch, MD, MS, Tomislav Mihaljevic, MD, Rory Hachamovitch, MD, Ashley M. Lowry, MS, Jiayan He, ScD, A. Marc Gillinov, MD, Eugene H. Blackstone, MD, Joseph F. Sabik, MD  The Annals of Thoracic Surgery  Volume 99, Issue 6, Pages (June 2015) DOI: /j.athoracsur Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Temporal trends in mitral valve surgery. Yearly frequencies are presented as symbols; lines are smoothing spline curves. (A) Proportion of 6,331 primary isolated operations that were actual repairs (closed squares and solid line, n = 5,902), intended replacements (closed circles and dashed line, n = 318), and repairs converted to replacement intraoperatively (closed triangles and dotted line, n = 111). (B) Temporal number of actual mitral valve repairs. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 Temporal trends in preoperative characteristics of patients presenting for mitral valve repair. (A) Temporal trend in New York Heart Association (NYHA) class. Lines represent smoothing spline curve and filled circles the mean percentage of patients in a given NHYA class each year (1985 to 2011). (B) Temporal trend in preoperative heart failure. Solid line represents smoothing spline curve and filled circles the mean percentage of patients with heart failure each year (1985 to 2011). (C) Temporal trend in preoperative atrial fibrillation or flutter. Solid line represents smoothing spline curve and filled circles the mean percentage of patients with preoperative atrial fibrillation or flutter each year (1985 to 2011). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Temporal trends in preoperative cardiac structure and function of patients presenting for mitral valve repair. (A) Temporal trend in preoperative calculated left ventricular (LV) end-diastolic volume index in patients who underwent mitral valve repair. Solid line represents smoothing spline curve and filled circles the mean value of preoperative calculated left ventricular end-diastolic volume each year (1986 to 2011). (B) Temporal trend in preoperative LV mass index (body surface area) in patients who underwent mitral valve repair. Solid line represents smoothing spline curve and filled circles the mean value of preoperative LV mass index each year (1986 to 2011). Dashed lines depict 95% upper limit of normal LV mass index for healthy adult men and women (men, 95 g • m−2; women, 75 g • m−2). (C) Temporal trend in preoperative left atrial diameter for patients who underwent mitral valve repair. Solid line represents smoothing spline curve and filled circles the mean value of preoperative left atrial diameter each year (1986 to 2011). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Temporal trends in outcomes after mitral valve repair. (A) Temporal trend in hospital deaths among patients who underwent mitral valve repair. Solid line represents smoothing spline curve, and filled circles represent the mean value of percentage of hospital deaths each year (1985 to 2011). (B) Temporal trend in postoperative length of stay among patients who underwent mitral valve repair. Solid line represents smoothing spline curve, and filled circles represent the mean value of operative length of stay each year (1985 to 2011). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions


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