The influence of a percutaneous mitral repair program on surgical mitral valve volume.
OBJECTIVE
Percutaneous mitral repair with the MitraClip system (Abbott Vascular, Santa Clara, Calif) has been available in trials since 2006 and is currently approved for patients with degenerative mitral valve disease at prohibitive risk for surgery. There has been concern that novel transcatheter approaches may detract from mitral valve surgical volumes. We sought to evaluate the influence of our MitraClip program on our surgical mitral valve volumes and outcomes.


METHODS
All patients referred for MitraClip underwent evaluation by a multidisciplinary team. Patients were screened for surgical candidacy and suitable valve anatomy for transcatheter repair. The fate of patients referred for MitraClip as well as the overall surgical mitral volumes and outcomes were evaluated.


RESULTS
From July 2007 to December 2014, 468 patients were referred for the MitraClip procedure at our institution. Of these, 156 patients (33.3%) received a MitraClip (including 45 implanted by surgeons), whereas 82 patients (17.5%) underwent surgical interventions. During this timeframe, the volume of isolated mitral valve operations increased from 50 procedures in 2007 to 93 in 2014 (80% increase; R(2) = 0.89). Importantly, operative mortality for all patients undergoing isolated mitral surgery from 2008 to 2014 was 2.6%, with an observed to expected ratio of 0.64.


CONCLUSIONS
The availability of MitraClip resulted in an increase in our mitral valve referrals. Despite seeing an increase in higher risk referrals, operative mortality for mitral surgery remained excellent. Multidisciplinary evaluation, including input from experienced mitral surgeons, is necessary to have a successful percutaneous and surgical mitral valve program.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
Emily
E
Downs
Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Va.
Scott
S
Lim
Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Va.
Michael
M
Ragosta
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
Kenan
K
Yount
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
Leora
L
Yarboro
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
Ravi
R
Ghanta
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
John
J
Kern
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va.
Irving
I
Kron
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va. Electronic address: gorav@virginia.edu.
Gorav
G
Ailawadi
D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D005260:Female; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D010348:Patient Care Team; D018579:Patient Selection; D017064:Process Assessment, Health Care; D015397:Program Evaluation; D011474:Prosthesis Design; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014768:Virginia
cardiac catheterization; mitral valve