STS 2023: Risk assessment tool “sets a high bar” when considering alternatives to surgery in mitral valve repair

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Vinay Badhwar

A new risk assessment tool has been produced to provide a comprehensive method for assessing operative risk of mitral valve repair for primary mitral regurgitation (MR).

In an article published jointly in both The Annals of Thoracic Surgery and the Journal of the American College of Cardiology (JACC), cardiology and cardiothoracic surgical researchers analysed recent US national data to assess the outcomes and risk of mitral valve repair for primary MR.

Assessing information from The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database, the team identified 53,462 patients who underwent planned surgical mitral valve repair for primary MR between 2014 and 2020.

The authors found that there was an increasing frequency of operations done in a minimally invasive fashion, including robotically, and that the rate of successful repair has reached over 90% in the USA. Researchers also found that risk of mortality after this surgery was rare across nearly all age ranges.

These data were used to develop a novel risk model for predicting 30-day outcomes based on the patient’s health conditions, which formed the basis for a new online risk calculator to assist healthcare providers to estimate the risks for their patients. This will be made available online shortly, according to the STS.

“The mortality risk model had excellent discrimination and calibration and confirmed very low mortality risk for isolated mitral valve repair,” said Robert Habib, director of research at STS, and the lead statistician behind the research. “For the vast majority of patients, the risk of death related to this procedure was less than 1%.”

“We have two options to treat primary mitral valve regurgitation. The historical standard has been surgical repair, but we also have US Food and Drug Administration (FDA)-approved transcatheter devices for minimally invasive mitral valve repair that have encouraging results, particularly in high-risk patients with primary MR,” said Vinay Badhwar (West Virginia University, Morgantown, USA), lead author of the multidisciplinary study. “Past perceptions of the risk of surgery and repair rates based on older risk models may have influenced the design of two clinical trials to explore transcatheter therapy in lower risk older individuals. The finding of 90% successful surgical repair with less than 1% mortality now achieved in the USA sets the outcome bar fairly high when considering alternative therapies to surgery. We hope this information will help physicians and patients make more informed decisions regarding treatment, as well as to inform the optimal design of future trials in the field.”

Now, with the new risk model calculator based on contemporary data, healthcare professionals will have a much more accurate assessment of the risk of mitral repair individualised to their patient’s medical profile, STS said in a press release.


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