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Mitral repair versus replacement: 20-year outcome trends in the UK (2000–2019)

OBJECTIVES: Using a large national database, we sought to describe outcome trends in mitral valve surgery between 2000 and 2019. METHODS: The study cohort was split into mitral valve repair (MVr) or replacement, including all patients regardless of concomitant procedures. Patients were grouped by fo...

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Autores principales: Al-Zubaidi, Fadi, Pufulete, Maria, Sinha, Shubhra, Kendall, Simon, Moorjani, Narain, Caputo, Massimo, Angelini, Gianni D, Vohra, Hunaid A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10250075/
https://www.ncbi.nlm.nih.gov/pubmed/37208195
http://dx.doi.org/10.1093/icvts/ivad086
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author Al-Zubaidi, Fadi
Pufulete, Maria
Sinha, Shubhra
Kendall, Simon
Moorjani, Narain
Caputo, Massimo
Angelini, Gianni D
Vohra, Hunaid A
author_facet Al-Zubaidi, Fadi
Pufulete, Maria
Sinha, Shubhra
Kendall, Simon
Moorjani, Narain
Caputo, Massimo
Angelini, Gianni D
Vohra, Hunaid A
author_sort Al-Zubaidi, Fadi
collection PubMed
description OBJECTIVES: Using a large national database, we sought to describe outcome trends in mitral valve surgery between 2000 and 2019. METHODS: The study cohort was split into mitral valve repair (MVr) or replacement, including all patients regardless of concomitant procedures. Patients were grouped by four-year admission periods into groups (A to E). The primary outcome was in hospital mortality and secondary outcomes were return to theatre, postoperative stroke and postoperative length of stay. We investigated trends over time in patient demographics, comorbidities, intraoperative characteristics and postoperative outcomes. We used a multivariable binary logistic regression model to assess the relationship between mortality and time. Cohorts were further stratified by sex and aetiology. RESULTS: Of the 63 000 patients in the study cohort, 31 644 had an MVr and 31 356 had a replacement. Significant demographic shifts were observed. Aetiology has shifted towards degenerative disease; endocarditis rates in MVr dropped initially but are now rising (period A = 6%, period C = 4%, period E = 6%; P < 0.001). The burden of comorbidities has increased over time. In the latest time period, women had lower repair rates (49% vs 67%, P < 0.001) and higher mortality rates when undergoing repair (3% vs 2%, P = 0.001) than men. Unadjusted postoperative mortality dropped in MVr (5% vs 2%, P < 0.001) and replacement (9% vs 7%, P = 0.015). Secondary outcomes have improved. Time period was an independent predictor for reduced mortality in both repair (odds ratio: 0.41, 95% confidence interval: 0.28–0.61, P < 0.001) and replacement (odds ratio: 0.50, 95% confidence interval: 0.41–0.61, P < 0.001). CONCLUSIONS: In-hospital mortality has dropped significantly over time for mitral valve surgery in the UK. MVr has become the more common procedure. Sex-based discrepancies in repair rates and mortality require further investigation. Endocarditis rates in MVS are rising.
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spelling pubmed-102500752023-06-09 Mitral repair versus replacement: 20-year outcome trends in the UK (2000–2019) Al-Zubaidi, Fadi Pufulete, Maria Sinha, Shubhra Kendall, Simon Moorjani, Narain Caputo, Massimo Angelini, Gianni D Vohra, Hunaid A Interdiscip Cardiovasc Thorac Surg Valvular Heart Disease OBJECTIVES: Using a large national database, we sought to describe outcome trends in mitral valve surgery between 2000 and 2019. METHODS: The study cohort was split into mitral valve repair (MVr) or replacement, including all patients regardless of concomitant procedures. Patients were grouped by four-year admission periods into groups (A to E). The primary outcome was in hospital mortality and secondary outcomes were return to theatre, postoperative stroke and postoperative length of stay. We investigated trends over time in patient demographics, comorbidities, intraoperative characteristics and postoperative outcomes. We used a multivariable binary logistic regression model to assess the relationship between mortality and time. Cohorts were further stratified by sex and aetiology. RESULTS: Of the 63 000 patients in the study cohort, 31 644 had an MVr and 31 356 had a replacement. Significant demographic shifts were observed. Aetiology has shifted towards degenerative disease; endocarditis rates in MVr dropped initially but are now rising (period A = 6%, period C = 4%, period E = 6%; P < 0.001). The burden of comorbidities has increased over time. In the latest time period, women had lower repair rates (49% vs 67%, P < 0.001) and higher mortality rates when undergoing repair (3% vs 2%, P = 0.001) than men. Unadjusted postoperative mortality dropped in MVr (5% vs 2%, P < 0.001) and replacement (9% vs 7%, P = 0.015). Secondary outcomes have improved. Time period was an independent predictor for reduced mortality in both repair (odds ratio: 0.41, 95% confidence interval: 0.28–0.61, P < 0.001) and replacement (odds ratio: 0.50, 95% confidence interval: 0.41–0.61, P < 0.001). CONCLUSIONS: In-hospital mortality has dropped significantly over time for mitral valve surgery in the UK. MVr has become the more common procedure. Sex-based discrepancies in repair rates and mortality require further investigation. Endocarditis rates in MVS are rising. Oxford University Press 2023-05-19 /pmc/articles/PMC10250075/ /pubmed/37208195 http://dx.doi.org/10.1093/icvts/ivad086 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Valvular Heart Disease
Al-Zubaidi, Fadi
Pufulete, Maria
Sinha, Shubhra
Kendall, Simon
Moorjani, Narain
Caputo, Massimo
Angelini, Gianni D
Vohra, Hunaid A
Mitral repair versus replacement: 20-year outcome trends in the UK (2000–2019)
title Mitral repair versus replacement: 20-year outcome trends in the UK (2000–2019)
title_full Mitral repair versus replacement: 20-year outcome trends in the UK (2000–2019)
title_fullStr Mitral repair versus replacement: 20-year outcome trends in the UK (2000–2019)
title_full_unstemmed Mitral repair versus replacement: 20-year outcome trends in the UK (2000–2019)
title_short Mitral repair versus replacement: 20-year outcome trends in the UK (2000–2019)
title_sort mitral repair versus replacement: 20-year outcome trends in the uk (2000–2019)
topic Valvular Heart Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10250075/
https://www.ncbi.nlm.nih.gov/pubmed/37208195
http://dx.doi.org/10.1093/icvts/ivad086
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