A complexity scoring system for degenerative mitral valve repair Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.

Anelechi C. Anyanwu, Shinobu Itagaki, Joanna Chikwe, Ahmed El-Eshmawi, David H. Adams

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

Abstract

Objective To develop a score to allow stratification of complexity in degenerative mitral valve repair. Methods Retrospective modeling of data from 668 consecutive patients who underwent surgery for mitral valve prolapse. A complexity scoring scale was developed using a consensus approach, assigning a score to each valve, based on the following: prolapsing segments (weight 1 for each posterior segment; weight 2 for each anterior or commissural segment); presence of valve restriction (weight 2); presence of calcification (weight 3 if annulus involved, otherwise weight 2); and prior mitral valve repair (weight 3). Valve repairs were categorized into 3 groups based on the complexity score: 1: Simple (n = 244); 2-4: Intermediate (n = 260); ≥5: Complex (n = 164). Results Mitral valve repair was successfully performed in 667 patients (repair rate: 99.9%). The complexity score was directly correlated with surrogates of technical complexity. The mean cardiopulmonary bypass time increased with lesion complexity ([in minutes] simple: 152; intermediate: 167; complex 195; P <.001). The median number of repair techniques utilized was related to lesion complexity (simple: 3; intermediate: 4; complex: 5; P <.001). Barlow's type etiology was more prevalent in complex cases (63%), compared with simple (9%) and intermediate (35%) cases (P <.001). Advanced repair techniques were required to complete repair in 51% of complex cases, compared with 14% of intermediate and 0% of simple cases (P <.001). Early and late outcomes were similar. Conclusions Our scoring system may allow effective stratification of complexity of mitral valve repair. Future studies are required to evaluate the use of our score in a prospective setting.

Original languageEnglish
Pages (from-to)1661-1670
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume151
Issue number6
DOIs
StatePublished - 1 Jun 2016

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