A complexity scoring system using echocardiography for repair of degenerative mitral valve regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHONG Zhaoji ¹ , ZHAO Xing ² , XU Jianping ¹ , SUN Hansong ¹ , SONG Yunhu ¹ , LV Feng ¹ , FENG Wei ¹ ,  LIU Sheng ¹

1. Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;
2. Department of Echocardiography, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding author：

LIU Sheng, Email: fuwailiusheng@sina.com

Keywords：

Degenerative mitral valve regurgitation; mitral valve repair; surgical complexity

DOI：

10.7507/1007-4848.201708051

Video：

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Objective To evaluate a score system to allow stratification of complexity in degenerative mitral valve repair. Methods We retrospectively reviewed the clinical data of 312 consecutive patients who underwent surgery for mitral valve repair and whose preoperative echocardiography was referable in our hospital from January 2012 to December 2013. A scoring system for surgical complexity was used based mainly on the preoperative echocardiography findings. Complexity of mitral valve repair was scored as 1 to 9, and patients were categorized into 3 groups based on the score for surgical complexity: a simple group (1 point), an intermediate group (2-4 points) and a complex group (≥5 points). There were 86 males and 35 females in the simple group (n=121) with an average age of 51.6±12.6 years, 105 males and 53 females in the intermediate group (n=158) with an average age of 51.1±12.8 years and 25 males and 8 females in the complex group (n=33) with an average age of 49.3±13.0 years. Results There was significant difference in surgical complexity in different groups. In the simple, intermediate and complex groups, the mean cardiopulmonary bypass time was 111.7±45.5 min, 117.7±40.4 min and 153.4±74.2 min (P<0.001), the mean cross-clamping time was 77.5±33.8 min, 83.2±29.9 min and 108.8±56.2 min (P<0.001), and the mean number of repair techniques utilized was 2.1±0.4, 2.4±0.6 and 2.8±0.8 (P<0.001). However, there was no significant difference in the early and late outcomes in different groups. Conclusion It is feasible to use echocardiography to quantitatively evaluate the difficulty of mitral valvuloplasty.

Citation： ZHONG Zhaoji, ZHAO Xing, XU Jianping, SUN Hansong, SONG Yunhu, LV Feng, FENG Wei, LIU Sheng. A complexity scoring system using echocardiography for repair of degenerative mitral valve regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(8): 696-700. doi: 10.7507/1007-4848.201708051 Copy

1.	Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol, 2014, 30(9): 962-970.
2.	Shuhaiber J, Anderson RJ. Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J Cardiothorac Surg, 2007, 31(2): 267-275.
3.	McNeely CA, Vassileva CM. Long-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review. Curr Cardiol Rev, 2015, 11(2): 157-162.
4.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2014, 148(1): e1-e132.
5.	Mick SL, Keshavamurthy S, Gillinov AM. Mitral valve repair versus replacement. Ann Cardiothorac Surg, 2015, 4(3): 230-237.
6.	Gillinov AM, Blackstone EH, Alaulaqi A, et al. Outcomes after repair of the anterior mitral leaflet for degenerative disease. Ann Thorac Surg, 2008, 86(3): 708-717.
7.	Johnston DR, Gillinov AM, Blackstone EH, et al. Surgical repair of posterior mitral valve prolapse: implications for guidelines and percutaneous repair. Ann Thorac Surg, 2010, 89(5): 1385-1394.
8.	Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J, 2010, 31(16): 1958-1966.
9.	Vassileva CM, McNeely C, Spertus J, et al. Hospital volume, mitral repair rates, and mortality in mitral valve surgery in the elderly: an analysis of US hospitals treating Medicare fee-for-service patients. J Thorac Cardiovasc Surg, 2015, 149(3): 762-768.
10.	LaPar DJ, Ailawadi G, Isbell JM, et al. Mitral valve repair rates correlate with surgeon and institutional experience. J Thorac Cardiovasc Surg, 2014, 148(3): 995-1003.
11.	Bolling SF, Li S, O'Brien SM, et al. Predictors of mitral valve repair: clinical and surgeon factors. Ann Thorac Surg, 2010, 90(6): 1904-1911.
12.	Anyanwu AC, Bridgewater B, Adams DH. The lottery of mitral valve repair surgery. Heart, 2010, 96(24): 1964-1967.
13.	Anyanwu AC, Itagaki S, Chikwe J, et al. A complexity scoring system for degenerative mitral valve repair. J Thorac Cardiovasc Surg, 2016, 151(6): 1661-1670.
14.	Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg, 2006, 82(3): 819-826.
15.	Seeburger J, Borger MA, Doll N, et al. Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse. Eur J Cardiothorac Surg, 2009, 36(3): 532-538.
16.	刘盛, 仲肇基, 尹朝华, 等. 二尖瓣成形术后再次手术: 从失败中获得的经验. 中国胸心血管外科临床杂志, 2016, 21(11): 1073-1076.
17.	Goldstone AB, Patrick WL, Cohen JE, et al. Early surgical intervention or watchful waiting for the management of asymptomatic mitral regurgitation: a systematic review and meta-analysis. Ann Cardiothorac Surg, 2015, 4(3): 220-229.
18.	Castillo JG, Anyanwu AC, Fuster V, et al. A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines. J Thorac Cardiovasc Surg, 2012, 144(2): 308-312.
19.	Goldstone AB, Cohen JE, Howard JL, et al. A "repair-all" strategy for degenerative mitral valve disease safely minimizes unnecessary replacement. Ann Thorac Surg, 2015, 99(6): 1983-1990.

1. Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol, 2014, 30(9): 962-970.
2. Shuhaiber J, Anderson RJ. Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J Cardiothorac Surg, 2007, 31(2): 267-275.
3. McNeely CA, Vassileva CM. Long-term outcomes of mitral valve repair versus replacement for degenerative disease: a systematic review. Curr Cardiol Rev, 2015, 11(2): 157-162.
4. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2014, 148(1): e1-e132.
5. Mick SL, Keshavamurthy S, Gillinov AM. Mitral valve repair versus replacement. Ann Cardiothorac Surg, 2015, 4(3): 230-237.
6. Gillinov AM, Blackstone EH, Alaulaqi A, et al. Outcomes after repair of the anterior mitral leaflet for degenerative disease. Ann Thorac Surg, 2008, 86(3): 708-717.
7. Johnston DR, Gillinov AM, Blackstone EH, et al. Surgical repair of posterior mitral valve prolapse: implications for guidelines and percutaneous repair. Ann Thorac Surg, 2010, 89(5): 1385-1394.
8. Adams DH, Rosenhek R, Falk V. Degenerative mitral valve regurgitation: best practice revolution. Eur Heart J, 2010, 31(16): 1958-1966.
9. Vassileva CM, McNeely C, Spertus J, et al. Hospital volume, mitral repair rates, and mortality in mitral valve surgery in the elderly: an analysis of US hospitals treating Medicare fee-for-service patients. J Thorac Cardiovasc Surg, 2015, 149(3): 762-768.
10. LaPar DJ, Ailawadi G, Isbell JM, et al. Mitral valve repair rates correlate with surgeon and institutional experience. J Thorac Cardiovasc Surg, 2014, 148(3): 995-1003.
11. Bolling SF, Li S, O'Brien SM, et al. Predictors of mitral valve repair: clinical and surgeon factors. Ann Thorac Surg, 2010, 90(6): 1904-1911.
12. Anyanwu AC, Bridgewater B, Adams DH. The lottery of mitral valve repair surgery. Heart, 2010, 96(24): 1964-1967.
13. Anyanwu AC, Itagaki S, Chikwe J, et al. A complexity scoring system for degenerative mitral valve repair. J Thorac Cardiovasc Surg, 2016, 151(6): 1661-1670.
14. Suri RM, Schaff HV, Dearani JA, et al. Survival advantage and improved durability of mitral repair for leaflet prolapse subsets in the current era. Ann Thorac Surg, 2006, 82(3): 819-826.
15. Seeburger J, Borger MA, Doll N, et al. Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse. Eur J Cardiothorac Surg, 2009, 36(3): 532-538.
16. 刘盛, 仲肇基, 尹朝华, 等. 二尖瓣成形术后再次手术: 从失败中获得的经验. 中国胸心血管外科临床杂志, 2016, 21(11): 1073-1076.
17. Goldstone AB, Patrick WL, Cohen JE, et al. Early surgical intervention or watchful waiting for the management of asymptomatic mitral regurgitation: a systematic review and meta-analysis. Ann Cardiothorac Surg, 2015, 4(3): 220-229.
18. Castillo JG, Anyanwu AC, Fuster V, et al. A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines. J Thorac Cardiovasc Surg, 2012, 144(2): 308-312.
19. Goldstone AB, Cohen JE, Howard JL, et al. A "repair-all" strategy for degenerative mitral valve disease safely minimizes unnecessary replacement. Ann Thorac Surg, 2015, 99(6): 1983-1990.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

A complexity scoring system using echocardiography for repair of degenerative mitral valve regurgitation

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