title: A complexity scoring system for degenerative mitral valve repair.
abstract: OBJECTIVE
  To develop a score to allow stratification of complexity in degenerative mitral valve repair.
  
  
  METHODS
  Retrospective modeling of data from 668 consecutive patients who underwent surgery for mitral valve prolapse. A complexity scoring scale was developed using a consensus approach, assigning a score to each valve, based on the following: prolapsing segments (weight 1 for each posterior segment; weight 2 for each anterior or commissural segment); presence of valve restriction (weight 2); presence of calcification (weight 3 if annulus involved, otherwise weight 2); and prior mitral valve repair (weight 3). Valve repairs were categorized into 3 groups based on the complexity score: 1: Simple (n = 244); 2-4: Intermediate (n = 260); ≥5: Complex (n = 164).
  
  
  RESULTS
  Mitral valve repair was successfully performed in 667 patients (repair rate: 99.9%). The complexity score was directly correlated with surrogates of technical complexity. The mean cardiopulmonary bypass time increased with lesion complexity ([in minutes] simple: 152; intermediate: 167; complex 195; P < .001). The median number of repair techniques utilized was related to lesion complexity (simple: 3; intermediate: 4; complex: 5; P < .001). Barlow's type etiology was more prevalent in complex cases (63%), compared with simple (9%) and intermediate (35%) cases (P < .001). Advanced repair techniques were required to complete repair in 51% of complex cases, compared with 14% of intermediate and 0% of simple cases (P < .001). Early and late outcomes were similar.
  
  
  CONCLUSIONS
  Our scoring system may allow effective stratification of complexity of mitral valve repair. Future studies are required to evaluate the use of our score in a prospective setting.
authors.affiliation: Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: anelechi.anyanwu@mountsinai.org.
authors.forename: Anelechi C
authors.initials: AC
authors.lastname: Anyanwu
authors.affiliation: Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Itagaki
authors.affiliation: Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Joanna
authors.initials: J
authors.lastname: Chikwe
authors.affiliation: Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Eshmawi
authors.affiliation: Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
mesh_terms: D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome