title: Mitral valve repair and replacement in northern New England.
abstract: BACKGROUND
  The etiology of mitral valvular disease has changed in the last 20 years, and new techniques for the diagnosis and repair of mitral valves have been advanced. A retrospective regional study was conducted to identify changes in patient and disease characteristics and in population-based rates for mitral valve repair and replacement in northern New England.
  
  
  METHODS
  Data from 1648 patients were collected from 5 clinical centers in Maine, New Hampshire, and Vermont between January 1, 1990, and December 31, 1999. U.S. Census data were used to calculate population-based rates.
  
  
  RESULTS
  Total mitral valve procedures increased 2.4 times, from 8.7 to 20.6 cases/100,000/year (p(trend) = 0.004). Primary procedures increased from 6.7 to 16.9 cases/100,000/year (p(trend) = 0.014). Primary mitral valve repair procedures increased 3.7 times, from 2.4 to 8.9 cases/100,000/year (p(trend) = 0.012), whereas mitral valve replacement increased only 1.9 times, from 4.3 to 8.0 cases/100,000/year (p(trend) = 0.016). Repeat mitral valve operations did not change significantly (p(trend) = 0.810). During this period, there was a significant increase of the percentage of octogenarians (p(trend) = 0.016) and of patients with ejection fractions <40% (p(trend) = 0.012). There was a decrease in the percentage of patients with mitral stenosis (p(trend) = 0.024).
  
  
  CONCLUSIONS
  In an era of a change in the etiology of mitral valvular disease and new techniques for diagnosis and repair of mitral valvular disease, regional data demonstrate substantial increased rates of mitral repair and replacement and expanded indications of older age and poorer left ventricular function.
authors.affiliation: Departments of Surgery and Medicine, Dartmouth Medical College, Hanover, NH, USA. Edward.R.Nowicki@Dartmouth.EDU
authors.forename: Edward R
authors.initials: ER
authors.lastname: Nowicki
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Weintraub
authors.forename: Nancy J O
authors.initials: NJ
authors.lastname: Birkmeyer
authors.forename: John H
authors.initials: JH
authors.lastname: Sanders
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Dacey
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lahey
authors.forename: Bruce
authors.initials: B
authors.lastname: Leavitt
authors.forename: Robert A
authors.initials: RA
authors.lastname: Clough
authors.forename: Reed D
authors.initials: RD
authors.lastname: Quinn
authors.forename: Gerald T
authors.initials: GT
authors.lastname: O'connor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019456:Health Transition; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008281:Maine / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000453:epidemiology / Q000601:surgery; D009513:New Hampshire / Q000453:epidemiology; D012189:Retrospective Studies; D013318:Stroke Volume; D014707:Vermont / Q000453:epidemiology