Contemporary trends and outcomes of mitral valve surgery for infective endocarditis.

BACKGROUND: Contemporary data on mitral valve (MV) surgery in patients with infective endocarditis (IE) are limited. METHODS: The National Inpatient Sample was queried to identify patients with IE who underwent MV surgery between 2003 and 2016. We assessed (a) temporal trends in the incidence of MV surgery for IE, (b) morbidity, mortality, and cost of MV repair vs replacement, and (c) predictors of in-hospital mortality. RESULTS: The proportion of MV operations involving patients with IE increased from 5.4% in 2003 to 7.3%, and the proportion of MV repair among those undergoing surgery for IE increased from 15.2% to 25.0% (Ptrend < .001). In-hospital mortality was higher in the replacement group (11.3% vs 8.1%; P < .001), and this excess mortality persisted after propensity score matching (11.2% vs 8.1%; P < .001), and in sensitivity analyses excluding concomitant surgery (unadjusted 11.3% vs 4.8%; adjusted 8.5% vs 4.5%; P < .001), and stratifying patients by the time of operation (within 7 days, 11.3% vs 6.8%; P < .001 and >7 days, 11.9% vs 9.1%; P = .012). In the propensity-matched cohorts, shock and need for tracheostomy were more frequent in the replacement group, but rates of stroke, pacemaker implantation, new dialysis, and blood transfusion were similar. Mitral valve repair was, however, associated with shorter hospitalizations, more home discharges, and less cost. In a multivariate regression analysis, age above 70 and chronic dialysis were the strongest predictors of in-hospital mortality. CONCLUSION: Mitral valve repair in IE patients is associated with lower in-hospital mortality, resource utilization, and cost compared with MV replacement.

Trends, clinical outcomes, and cost implications of mitral valve repair versus replacement, concomitant with aortic valve replacement.

OBJECTIVE: This study evaluated national trends, clinical outcomes, and cost implications of mitral valve (MV) repair, versus replacement, concomitant with aortic valve replacement (AVR). METHODS: Patients who underwent MV surgery concomitant with AVR, between 1999 and 2008, were identified in the Nationwide Inpatient Sample (NIS) registry. Mitral stenosis, endocarditis, and emergency cases were excluded. Inpatient clinical outcomes and costs were compared. Costs were derived using cost-to-charge ratios supplied by the dataset for each individual hospital. Multivariable logistic and linear regression analyses were used for risk adjustment. RESULTS: A total of 41,417 concomitant cases were identified, of which 11,472 (28%) were MV repairs. Repair rates increased from 15.3% in 1999 to 43.5% in 2008 (P < .001). Major postoperative morbidity rates were similar with MV repair, versus replacement, concomitant with AVR (each 29%, P = .54). Unadjusted inpatient mortality (7.9% vs 10.1%, P = .005); length of hospital stay (median: 8 vs 9 days, P < .001); and costs (median: $45,455 vs $49,648, P < .001) were lower with MV repair. After risk adjustment, MV repair was associated with lower odds of inpatient mortality, and with lower costs (each P < .001). CONCLUSIONS: Mitral valve repair concomitant with AVR is associated with reduced inpatient mortality and costs, compared with MV replacement, supporting its use when technically feasible. Although use has increased substantially, MV repair continues to comprise a minority of concomitant AVR cases, in centers reporting to the NIS registry. Increasing repair rates, particularly in NIS-participating hospitals, seems prudent.