25. Contemporary Results of Operations for Mitral Regurgitation Caused by Posterior Leaflet Prolapse: The AATS Adult Quality Gateway

Contemporary Results of Operations for Mitral Regurgitation Caused by Posterior Leaflet Prolapse: The AATS Adult Quality Gateway
Marc Gillinov, MD, Lars G. Svensson, MD, PhD, Eugene H. Blackstone, MD, Hemant Ishwaran, PhD, Linda DiPaolo, BA, Edward G. Soltesz, MD, MPH, Arnar Geirsson, MD, Leonard N. Girardi, MD, Emile A. Bacha, MD, David H. Adams, MD
Objective: In patients undergoing surgical repair of posterior mitral valve prolapse, to compare results predicted by the AATS Adult Quality Gateway (AQG) to observed results and to those predicted by the STS Adult Cardiac Surgery Database (STS ACSD).
Methods: The AQG employs novel algorithms that require limited patient data entry (83 variables vs.225 for the STS ACSD) enabling an efficient approach to evaluating outcomes of a wide variety of surgical procedures. Deidentified data were obtained from 3 hospital systems (19 hospitals) on 55,246 adult patients. This study included data from the 5 hospitals that performed the most operations for posterior mitral valve prolapse (1471 repairs (97%) and 46 replacements (3%)). Patients had mitral valve surgery with or without ablation for atrial fibrillation (n=282), left atrial appendage closure (n=359), tricuspid valve procedure (n=367) and closure of a PFO or ASD (n=91).
Results: Among the 97% of patients who had mitral valve repair, repair techniques included leaflet resection (80%), creation of artificial chordae (20%) and annuloplasty (99%). Patients undergoing valve replacement were more likely to be older with higher NYHA class and had more tricuspid regurgitation and mitral annular calcification. In repair patients, surgical approach was sternotomy or partial sternotomy in 945 patients (64%) and right thoracotomy/robotic in 525 patients (36%). Predicted mortality and major morbidity after mitral valve repair were similar between the AQG and STS ACSD; these 5 hospitals with extensive experience in mitral valve surgery had lower mortality (0.07%) and less morbidity (4%) than predicted by either model (Table).
Conclusion: Requiring entry of a limited number of variables, the AQG's predicted results for mitral valve surgery in patients with prolapse are similar to those obtained from the STS ACSD. This efficient and novel database enables both prediction and assessment of a center's results, in this case demonstrating that high volume mitral valve centers of excellence achieve better than expected outcomes in the management of mitral valve prolapse.

Marc Gillinov (1), Lars Svensson (1), Eugene Blackstone (1), Hemant Ishwaran (1), Linda DiPaola (1), Edward Soltesz (1), Arnar Geirsson (2), Leonard Girardi (3), Emile Bacha (2), David Adams (4), (1) Cleveland Clinic, Cleveland, OH, (2) NewYork- Presbyterian/Columbia University Medical Center, New York, NY, (3) Weill Cornell Medical Center, New York, NY, (4) Icahn School of Medicine at Mount Sinai, New York, New York, New York, NY

Marc Gillinov

Abstract Presenter

Marc Gillinov, M.D. is Professor and Chair of the Department of Thoracic and Cardiovascular Surgery at Cleveland Clinic. Cleveland Clinic is North America’s largest cardiac surgery program, performing more than 5,000 cardiac surgical procedures annually at its Main Campus in Cleveland, Ohio. Dr. Gillinov has a particular interest in mitral valve repair with a focus on robotic mitral valve surgery. He has written extensively on robotic mitral valve repair and has produced a series of educational surgical videos and manuscripts with the intention of “demystifying” mitral valve repair in degenerative disease.

Dr. Gillinov also serves as Chair of the NIH-funded Cardiothoracic Surgical Trials Network (CTSN), the world’s premier cardiac surgical research enterprise. Under Dr. Gillinov’s leadership, the CTSN has conducted numerous randomized controlled trials that have informed guidelines and changed clinical practice.

Dr. Gillinov has been an AATS member for 25 years, and his AATS activities have included Program Co-Director for the Annual Meeting, Co-Director of the STARS meeting, Board membership in the AATS Foundation, and membership and leadership of several AATS committees. Dr. Gillinov has been appointed as a Director of the American Association for Thoracic Surgery, and, reflecting his commitment to training and education, is the designated Director for Education.

He lives in Cleveland, Ohio with his wife, Lisa.

Steven Bolling

Commentator

Dr. Steven F. Bolling is a Professor of Surgery in the Department of Cardiac Surgery at the University of Michigan.  Both his undergraduate and medical school education was at the University of Michigan.  Following this, he trained in general and thoracic surgery at Johns Hopkins.

He joined the Cardiac Surgery faculty at the University of Michigan in the mid-1980s and helped create and direct the multi-disciplinary mitral valve clinic.  He is an active participant in all the major cardiac surgical societies and a recognized expert in mitral valve surgery.  He is the author of over 350 peer-reviewed publications and holds numerous grants, including NIH, AHA, and industry grants.

His expertise and innovative approach to mitral valve repair in patients with end-stage left ventricular failure and outstanding ability to repair even the most challenging mitral valve abnormalities have received widespread international acclaim. He continues to run a basic science laboratory and the MMRG.

Specialties: Congenital, Multi-Specialty, Thoracic