Mitral valve repair and replacement in northern New England.
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.
Nowicki
Edward R
ER
Departments of Surgery and Medicine, Dartmouth Medical College, Hanover, NH, USA. Edward.R.Nowicki@Dartmouth.EDU
Weintraub
Ronald W
RW
Birkmeyer
Nancy J O
NJ
Sanders
John H
JH
Dacey
Lawrence J
LJ
Lahey
Stephen J
SJ
Leavitt
Bruce
B
Clough
Robert A
RA
Quinn
Reed D
RD
O'connor
Gerald T
GT
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