title: Trends, clinical outcomes, and cost implications of mitral valve repair versus replacement, concomitant with aortic valve replacement.
abstract: 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.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: Arman
authors.initials: A
authors.lastname: Kilic
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Grimm
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: J Trent
authors.initials: JT
authors.lastname: Magruder
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Sciortino
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: Glenn J R
authors.initials: GJ
authors.lastname: Whitman
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
authors.forename: William A
authors.initials: WA
authors.lastname: Baumgartner
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md. Electronic address: jconte@jhmi.edu.
authors.forename: John V
authors.initials: JV
authors.lastname: Conte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000639:trends*; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000639:trends*; D018803:Models, Economic; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: aortic valve replacement; health care costs; mitral valve repair; mitral valve replacement; patient outcomes