title: Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database.
abstract: BACKGROUND
  The purpose of this study is to examine trends in mitral valve (MV) repair and replacement surgery using The Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS ACSD).
  
  
  METHODS
  The study population included isolated mitral valve operations performed between January 2000 and December 2007 at 910 hospitals participating in the STS ACSD. Patients with endocarditis, prior cardiac operation, shock, emergency operation, and concomitant coronary artery bypass graft or aortic valve surgery were excluded.
  
  
  RESULTS
  During the 8-year study period, 58,370 patients underwent isolated primary MV operations. For patients with isolated mitral regurgitation (n = 47,126), the rate of MV repair (versus replacement) increased from 51% to 69% (p < 0.0001). Among patients having replacement (n = 24,404), there has been a pronounced decline in the use of mechanical valves: 68% to 37% (p < 0.0001). The operative mortality for MV replacement was consistently higher than that for repair (3.8% versus 1.4%), a finding that persisted after risk-adjustment (adjusted odds ratio 0.52, 95% confidence interval: 0.45 to 0.59; p < 0.0001). Among patients having elective isolated MV repair (n = 28,140), the operative mortality was 1.2%. For asymptomatic (class I) patients, operative mortality was 0.6%.
  
  
  CONCLUSIONS
  This study documents several important trends in MV surgery, including the progressive adoption of mitral valve repair and increasing use of bioprosthetic replacement valves. Operative risks of MV repair are significantly lower than those for MV replacement. Operative mortality for isolated elective mitral valve repair is 1% in contemporary clinical practice.
authors.affiliation: Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland 21201, USA. jgammie@smail.umaryland.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.forename: Shubin
authors.initials: S
authors.lastname: Sheng
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: J Scott
authors.initials: JS
authors.lastname: Rankin
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: James M
authors.initials: JM
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D018579:Patient Selection; D012044:Regression Analysis; D012307:Risk Factors; D012955:Societies, Medical; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome; D014481:United States