A. Reisman1, A. Thomas1, P. Boateng1, I. Leitman1 1Icahn School of Medicine at Mount Sinai,New York, NY, USA
Introduction: Mitral valve repair has been established as the preferred treatment option in the management of degenerative mitral valve disease. Compared with other surgical treatment options, mitral valve repair is associated with increased survival and decreased rates of both complications and reoperations. However, among patients undergoing mitral valve repair, little is known about the predictors of postoperative outcomes. The purpose of this study was to identify preoperative patient risk factors associated with morbidity and mortality within 30 days of mitral valve repair.
Methods: Data were derived from the American College of Surgeons National Surgical Quality Improvement Program database to assess patients who underwent mitral valve repair from 2011 through 2016. Preoperative risk factors were analyzed to determine their association with a variety of postoperative 30-day outcome measures.
Results: One thousand two hundred and thirty-four patients underwent mitral valve repair; 763 (61.8%) males and 471 (38.2%) females. Ages ranged from 18 to 89 years, with a median age of 65 years. The overall 30-day mortality was 3% (37 patients). Among the 12 identified risk factors associated with increased mortality, pre-operative hematocrit level was the only variable significantly correlated with mortality after undergoing multivariate analysis. 235 patients (19.2%) were discharged to a location other than home, an outcome associated with 21 identified risk factors. Among these risk factors, female gender, age, hypertension requiring medication, dialysis, pre-operative serum sodium, and pre-operative serum albumin remained statistically significant following multivariate analysis. 121 patients (9.8%) experienced unplanned readmission. This outcome was associated with eight risk factors, of which only dyspnea upon mild exertion was significant on multivariate analysis. Reoperation occurred in 99 patients (8.1%). Of the 6 identified variables associated with reoperation, patient age was the only independent predictor on multivariate analysis. 49 patients (4.0%) underwent reintubation, which was associated with 13 identified risk factors. Among them, patient age and pre-operative INR value were predictive of reintubation on multivariate analysis.
Conclusion: Outcomes are good following mitral valve repair. Although a substantial number of risk factors were found to be associated with adverse outcomes, only a small subset remained significantly significant following multivariate analysis. Identification of these risk factors may help guide clinical decision making with respect to which patients are the best candidates to undergo mitral valve repair.
