The following is a summary of “Risk of Surgical Mitral Valve Repair for Primary Mitral Regurgitation,” published in the February 2023 issue of Cardiology by Badhwar, et al.

The heart team’s collaborative decision-making process must include the evaluation of surgical intervention risk. Unfortunately, etiologic or procedural specificity was lacking in the risk models currently being utilized in practice for mitral valve (MV) surgery. Therefore, for a study, researchers sought to provide a comprehensive technique for assessing the risk of primary mitral regurgitation (MR) MV repair surgery.

53,462 consecutive (July 2014–June 2020) intention-to-treat MV repair patients with primary MR were found in the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons. Risk models were developed for 30-day operational mortality, mortality and/or significant morbidity, and conversion to replacement (CONV). In addition, separate as-treated mortality and morbidity models were created.

Mortality event rates were modest (n = 619; 1.16%), as were mortality plus morbidity (n = 4,746; 8.88%) and CONV (n = 3,399; 6.36%). Recurrent patients had a greater mortality rate than repair patients (3.18% vs. 1.02%). With rising program volumes, all event rates decreased. With a mean mortality risk of 1.16% and a median mortality risk of 0.55% (IQR: 0.30%-1.17%) and 90th and 95th percentiles of 2.48% and 3.99%, respectively, the mortality risk model had excellent discrimination (AUC: 0.807), calibration, and confirmed very low mortality risk for isolated MV repair for primary MR. Patients <65 had a mortality risk of 0.5%, while the risk for 97% of the population overall across all age categories was <3%. Greater than 3% estimated mortality risk was seen in only 1 in 4 individuals 75 years of age or older.

The etiologic and procedure-specific risk model determined that the vast majority of patients had a contemporary mortality risk of 1% for MV repair for primary MR.

Reference: jacc.org/doi/10.1016/j.jacc.2022.11.017