Surgery for degenerative mitral valve disease becoming more safe, effective

An analysis of more than 25 years of data at the Cleveland Clinic found that surgical procedures were more successful than “watchful waiting” for patients with severe degenerative mitral regurgitation.

Farhang Yazdchi, MD, MS, of Brigham and Women’s Hospital in Boston, and colleagues published their findings online in the Annals of Thoracic Surgery on June 1.

Since the 1980s, they noted more patients with degenerative mitral valve disease underwent surgery before they had symptoms. Surgical options have also become less invasive, more effective and safer, according to Yazdchi et al.

They examined 6,331 patients who underwent primary isolated mitral valve surgery for degenerative mitral valve disease and severe regurgitation at the Cleveland Clinic from Jan. 1, 1985 to Jan. 1, 2011. Of the procedures, 6,013 were intended primary isolated mitral valve repairs and 318 were mitral valve replacements.

The researchers broke the procedures into the following time periods: from 1985 to 1997 (era 1), from 1997 to 2005 (era 2) and from 2005 to 2011 (era 3). They found the number of mitral valve repair procedures increased from 1,184 in era 1 to 2,318 in era 3.

The procedures also have become more common in patients without symptoms. For instance, 29 percent of patients who underwent surgery in era 1 had a history of heart failure compared with 16 percent of patients in era 2 and 11 percent of patients in era 3. Preoperative atrial fibrillation decreased from 23 percent in era 1 to 13 percent in era 2 to 9.9 percent in era 3.

The researchers also noted that less invasive surgical approaches occurred in 7 percent of patients in era 1, 75 percent of patients in era 2 and 69 percent of patients in era 3. They defined less invasive procedures as partial sternotomy, right anterior thoracotomy and robotic.

Postoperative mortality was 0.42 percent in era 1, 0.21 percent in era 2 and 0.043 percent in era 3. The length of hospital stay after surgery decreased from a mean of seven days in era 1 to 5.9 days in era 2 to 5.2 days in era 3.