AATS: Is Survival Always Better after Valve Repair than after Valve Replacement for Degenerative Mitral Valve Disease?

Is Survival Always Better after Valve Repair than after Valve Replacement for Degenerative Mitral Valve Disease?

A. Marc Gillinov¹, Eugene H. Blackstone¹, Edward R. Nowicki¹, Worawong Slisatkorn¹, Ghannam Al-Dossari², Douglas R. Johnston¹, Kristopher M. George¹, Penny L. Houghtaling², Brian Griffin², Joseph F. Sabik¹, Lars G. Svensson¹; ¹Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH; ²Cleveland Clinic, Cleveland, OH

Objective: Survival after mitral valve replacement for degenerative disease is thought to be worse than after valve repair; however, this may not apply to all patients and may be due to patient mix (marker) rather than to an independent effect of replacement (risk factor). We sought to 1) identify characteristics differentiating patients undergoing replacement rather than repair, and 2) use this information to compare survival after each procedure.

Methods: From 1985 to 2005, 3,286 patients underwent isolated primary operation for degenerative mitral valve disease: 3,051 (93%) valve repair and 235 (7.2%) valve replacement. Patients undergoing replacement were older (70±12 vs. 57±13 years) and had more advanced symptoms, left ventricular dysfunction, and valvar pathology. From these differences, a propensity model and score were developed. Propensity matching yielded 195 matched pairs, the patients in each pair being more similar to typical replacement patients (older, more comorbidities) than to typical repair patients.

Results: Among the 3,051 patients undergoing repair, there were 8 hospital deaths (0.26%) compared with 5 (2.1%) after replacement (P=.001). Unadjusted survival estimates at 1, 5, 10, and 15 years were 98%, 95%, 87%, and 68% after repair and 92%, 80%, 60%, and 44% after replacement (P<.0001; Figure). However, among higher risk propensity-matched patients, survival was similar (P=.8) after repair and replacement (Figure).

Conclusion: In an institution in which mitral valve repair is distinctly preferred, patients undergoing valve replacement rather than repair for degenerative mitral regurgitation represent a subset of older, sicker patients with advanced heart disease. At this extreme end of the spectrum, we were unable to identify a survival advantage of mitral repair vs. replacement.

Back to Annual Meeting
Back to Program Outline