Correlation between the Complexity Score and the Outcome of Mitral Valve Repair

Masaki Nakamura, Yutaka Sakakibara, Takeshi Ikuno, Yusuke Seki, Kazunobu Nishimura

Takamatsu Red Cross hospital, Takamatsu, Japan

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–B

Abstract

OBJECTIVE: Preoperative evaluation of mitral valve is very important for obtaining favorable results. A scoring system reported by Anelechi C. Anyanwu was useful for judgement of complexity of valve repair in degenerative mitral valve repair. The purpose of this study is to evaluate the correlation between the complexity score and the difficulty and the outcome of mitral valve repair.

METHODS: A total of 111 patients underwent degenerative mitral valve repair between 2009 and 2017. Seventeen-nine patients were male and the average age was 64 years old. The mean follow-up period was 2.9 years. The cause of mitral regurgitation was degenerative change in 104, and infective endocarditis in 7. We used the complexity socore mentioned above, (weight 1 for each posterior segment, weight 2 for each anterior segment, each commissure, leaflet restriction, leaflet thickening, and papillary muscle calcification, weight 3 for previous mitral repair). All patients were divided into Simple(n=60) and Complex(n=51) group based on the complexity score. Score 1-2 were assigned in Simple, while score over 3 in Complex.

RESULTS: Mitral valve annuloplasty was performed in all cases. The mean number of technique to repair was significantly fewer in Simple than Complex (Simple 2.5 vs Complex 3.1 P=0.017). Cardiopulmonary bypass time, and residual mitral regurgitation grade were similar in two groups. The success rate of mitral valve repair was not significantly different between two groups (Simple 93.3% vs Complex 86.3% P=0.24). The overall survival rate at 5 years and freedom from mitral valve replacement at 3 years were 95.9% and 90.0% in Simple, 89.5% and 76.4 in Complex. There was no statistical difference (log rank, P=0.49 and 0.18).

CONCLUSION:The complexity score is useful to evaluate the difficulty of mitral valve repair. This system can be applied as an indication of minimally invasive cardiac surgery or training of young surgeons.