Surgical outcomes of patients at prohibitive risk who are reconsidered for surgeryCentral MessagePerspective
Objectives: Transcatheter treatment of advanced mitral and tricuspid valve disease is largely limited to patients at prohibitive surgical risk, although many are not candidates for transcatheter treatment. Here, we describe surgical outcomes of patients at prohibitive risk who were ineligible for tr...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623002620 |
| _version_ | 1797385026355068928 |
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| author | Catherine M. Wagner, MD Megan L. Schultz, MD Alexander A. Brescia, MD, MSc Yoyo Wang, BS Whitney Fu, MD Robert B. Hawkins, MD, MSc Matthew A. Romano, MD Gorav Ailawadi, MD, MBA Steven F. Bolling, MD |
| author_facet | Catherine M. Wagner, MD Megan L. Schultz, MD Alexander A. Brescia, MD, MSc Yoyo Wang, BS Whitney Fu, MD Robert B. Hawkins, MD, MSc Matthew A. Romano, MD Gorav Ailawadi, MD, MBA Steven F. Bolling, MD |
| author_sort | Catherine M. Wagner, MD |
| collection | DOAJ |
| description | Objectives: Transcatheter treatment of advanced mitral and tricuspid valve disease is largely limited to patients at prohibitive surgical risk, although many are not candidates for transcatheter treatment. Here, we describe surgical outcomes of patients at prohibitive risk who were ineligible for transcatheter therapies to guide surgeons in management of this unique population. Methods: Patients at prohibitive risk, defined per surgeon or cardiologist discretion, who were initially referred for a transcatheter mitral or tricuspid intervention in a multidisciplinary atrioventricular valve clinic, were identified from 2019 to 2022. Preoperative risk, operative outcomes, and long-term mortality were evaluated. Results: A total of 337 patients at prohibitive risk were referred for evaluation in a multidisciplinary atrioventricular valve clinic. Of those, 161 underwent transcatheter therapy, 130 patients underwent continued medical management, and 45 were reevaluated and had high-risk surgery. Among surgical patients, 51% were women with a median age of 76 years (quartile 1-quartile 3, 65-81 years). Most patients presented in heart failure (83%; n = 37 out of 45), and 73% were in New York Heart Association functional class III or IV. Most patients (94%; n = 43) had a mitral valve intervention, of whom 56% (24 out of 43) had a mitral valve replacement. The 30-day mortality rate was 4% (2 out of 45) and major morbidity occurred in 33% (15 out of 45). By Kaplan-Meier analysis, 1-year survival was 86% ± 9%. Conclusions: Select patients at prohibitive risk who were ineligible for transcatheter mitral or tricuspid valve intervention underwent surgery with overall low operative mortality and excellent 1-year survival. Patients a prohibitive risk whose anatomy is not amenable to transcatheter devices should be reconsidered for surgery. |
| first_indexed | 2024-03-08T21:48:10Z |
| format | Article |
| id | doaj.art-80a16187d74e4c8aab5f3dea6a2fc96e |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-08T21:48:10Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-80a16187d74e4c8aab5f3dea6a2fc96e2023-12-20T07:38:10ZengElsevierJTCVS Open2666-27362023-12-0116234241Surgical outcomes of patients at prohibitive risk who are reconsidered for surgeryCentral MessagePerspectiveCatherine M. Wagner, MD0Megan L. Schultz, MD1Alexander A. Brescia, MD, MSc2Yoyo Wang, BS3Whitney Fu, MD4Robert B. Hawkins, MD, MSc5Matthew A. Romano, MD6Gorav Ailawadi, MD, MBA7Steven F. Bolling, MD8Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; Address for reprints: Catherine M. Wagner, MD, Department of Cardiac Surgery, University of Michigan, 5344 Cardiovascular Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109.Department of Cardiac Surgery, University of Michigan, Ann Arbor, MichDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, MichUniversity of Michigan Medical School, Ann Arbor, MichDepartment of General Surgery, University of Michigan, Ann Arbor, MichDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, MichDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, MichDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, MichDepartment of Cardiac Surgery, University of Michigan, Ann Arbor, MichObjectives: Transcatheter treatment of advanced mitral and tricuspid valve disease is largely limited to patients at prohibitive surgical risk, although many are not candidates for transcatheter treatment. Here, we describe surgical outcomes of patients at prohibitive risk who were ineligible for transcatheter therapies to guide surgeons in management of this unique population. Methods: Patients at prohibitive risk, defined per surgeon or cardiologist discretion, who were initially referred for a transcatheter mitral or tricuspid intervention in a multidisciplinary atrioventricular valve clinic, were identified from 2019 to 2022. Preoperative risk, operative outcomes, and long-term mortality were evaluated. Results: A total of 337 patients at prohibitive risk were referred for evaluation in a multidisciplinary atrioventricular valve clinic. Of those, 161 underwent transcatheter therapy, 130 patients underwent continued medical management, and 45 were reevaluated and had high-risk surgery. Among surgical patients, 51% were women with a median age of 76 years (quartile 1-quartile 3, 65-81 years). Most patients presented in heart failure (83%; n = 37 out of 45), and 73% were in New York Heart Association functional class III or IV. Most patients (94%; n = 43) had a mitral valve intervention, of whom 56% (24 out of 43) had a mitral valve replacement. The 30-day mortality rate was 4% (2 out of 45) and major morbidity occurred in 33% (15 out of 45). By Kaplan-Meier analysis, 1-year survival was 86% ± 9%. Conclusions: Select patients at prohibitive risk who were ineligible for transcatheter mitral or tricuspid valve intervention underwent surgery with overall low operative mortality and excellent 1-year survival. Patients a prohibitive risk whose anatomy is not amenable to transcatheter devices should be reconsidered for surgery.http://www.sciencedirect.com/science/article/pii/S2666273623002620mitral diseasetricuspid diseaseheart teamprohibitive risk |
| spellingShingle | Catherine M. Wagner, MD Megan L. Schultz, MD Alexander A. Brescia, MD, MSc Yoyo Wang, BS Whitney Fu, MD Robert B. Hawkins, MD, MSc Matthew A. Romano, MD Gorav Ailawadi, MD, MBA Steven F. Bolling, MD Surgical outcomes of patients at prohibitive risk who are reconsidered for surgeryCentral MessagePerspective JTCVS Open mitral disease tricuspid disease heart team prohibitive risk |
| title | Surgical outcomes of patients at prohibitive risk who are reconsidered for surgeryCentral MessagePerspective |
| title_full | Surgical outcomes of patients at prohibitive risk who are reconsidered for surgeryCentral MessagePerspective |
| title_fullStr | Surgical outcomes of patients at prohibitive risk who are reconsidered for surgeryCentral MessagePerspective |
| title_full_unstemmed | Surgical outcomes of patients at prohibitive risk who are reconsidered for surgeryCentral MessagePerspective |
| title_short | Surgical outcomes of patients at prohibitive risk who are reconsidered for surgeryCentral MessagePerspective |
| title_sort | surgical outcomes of patients at prohibitive risk who are reconsidered for surgerycentral messageperspective |
| topic | mitral disease tricuspid disease heart team prohibitive risk |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623002620 |
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