Validation of a Risk Calculator for Surgical Repair of Primary Mitral Regurgitation

Serdar Akansel; Martina Dini; Simon H. Sündermann; Stephan Jacobs; Volkmar Falk; Jörg Kempfert; Markus Kofler

doi:10.1055/a-2650-6994

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg
DOI: 10.1055/a-2650-6994

Original Cardiovascular

Validation of a Risk Calculator for Surgical Repair of Primary Mitral Regurgitation

Serdar Akansel

¹Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany

²Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

,

Martina Dini

¹Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany

²Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

,

Simon H. Sündermann

¹Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany

²Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

³German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany

,

Stephan Jacobs

¹Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany

²Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

³German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany

,

Volkmar Falk

¹Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany

²Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

³German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany

⁴ETH Zurich, Department of Health Sciences and Technology, Zurich, Switzerland

,

Jörg Kempfert

¹Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany

²Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

³German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany

,

Markus Kofler

¹Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany

²Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

³German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany

› Author Affiliations

Abstract

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Abstract

Objective

Risk estimation for cardiac procedures is essential for clinical decision-making. The aim of the study is to validate the recently introduced Society of Thoracic Surgeons (STS) risk score model for mitral valve repair (MVr) in degenerative mitral regurgitation (DMR) by investigating a large cohort undergoing minimally invasive MVr (MI-MVr).

Methods

A total of 1,081 consecutive patients with DMR undergoing non-emergent MI-MVr were retrospectively analyzed. The primary study endpoint was 30-day all-cause mortality (OM), while secondary endpoints were major morbidity and mortality (MM) and conversion-to-replacement (CONV). Predictive discrimination and calibration of the models were measured using receiver operating characteristic (ROC) analysis.

Results

A 30-day mortality of 0.55% was observed in the study cohort. All risk scores were significantly higher in non-survivors. Like existing risk models, the intention-to-treat-OM (ITT-OM) model was predictive for OM (OR: 2.078, 95% CI: 1.324–3.621; p = 0.001), but its discriminatory ability was limited based on ROC analysis. EuroSCORE II showed the best discriminatory performance for mortality among the investigated models. Furthermore, second cross-clamping and CONV were independent predictors of OM (OR: 26.2, 95% CI: 4.3–160.0; p < 0.001 and OR: 12.8, 95% CI: 1.8–89.2; p = 0.010). The ITT-MM and ITT-CONV models demonstrated an acceptable discriminatory ability for predicting operative MM and CONV.

Conclusion

The ITT-based risk model was validated in our study cohort undergoing MI-MVr for DMR, showing only limited discriminatory performance for mortality, while the EuroSCORE II demonstrated better discrimination for mortality despite systematic overestimation. This is the first report validating the recently introduced model. However, further studies with larger cohorts are needed to overcome the limitations of the present study.

Keywords

mitral valve surgery - minimally invasive mitral valve repair - outcomes

Full Text

References

References
1 Nashef SAM, Roques F, Sharples LD. et al. EuroSCORE II. Eur J Cardiothorac Surg 2012; 41 (04) 734-744 , discussion 744–745
2 Badhwar V, Rankin JS, He X. et al. The Society of Thoracic Surgeons Mitral Repair/Replacement Composite Score: A report of The Society of Thoracic Surgeons Quality Measurement Task Force. Ann Thorac Surg 2016; 101 (06) 2265-2271
3 Di Dedda U, Pelissero G, Agnelli B, De Vincentiis C, Castelvecchio S, Ranucci M. Accuracy, calibration and clinical performance of the new EuroSCORE II risk stratification system. Eur J Cardiothorac Surg 2013; 43 (01) 27-32
4 Chalmers J, Pullan M, Fabri B. et al. Validation of EuroSCORE II in a modern cohort of patients undergoing cardiac surgery. Eur J Cardiothorac Surg 2013; 43 (04) 688-694
5 Barili F, Pacini D, Capo A. et al. Does EuroSCORE II perform better than its original versions? A multicentre validation study. Eur Heart J 2013; 34 (01) 22-29
6 Guida P, Mastro F, Scrascia G, Whitlock R, Paparella D. Performance of the European System for Cardiac Operative Risk Evaluation II: a meta-analysis of 22 studies involving 145,592 cardiac surgery procedures. J Thorac Cardiovasc Surg 2014; 148 (06) 3049-57.e1
7 Gammie JS, Chikwe J, Badhwar V. et al. Isolated mitral valve surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis. Ann Thorac Surg 2018; 106 (03) 716-727
8 Badhwar V, Chikwe J, Gillinov AM. et al. Risk of surgical mitral valve repair for primary mitral regurgitation. J Am Coll Cardiol 2023; 81 (07) 636-648
9 Vahanian A, Alfieri O, Andreotti F. et al.; ESC Committee for Practice Guidelines (CPG), Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2012; 42 (04) S1-S44
10 Falk V, Baumgartner H, Bax JJ. et al.; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2017; 52 (04) 616-664
11 Akansel S, Kofler M, Van Praet KM. et al. Image-based ring size prediction for mitral valve repair. Eur J Cardiothorac Surg 2023; 64 (01) ezad212
12 Akansel S, Kofler M, Van Praet KM. et al. Minimally invasive mitral valve surgery after failed transcatheter mitral valve repair in an intermediate-risk cohort. Interact Cardiovasc Thorac Surg 2022; 35 (02) ivac163
13 Van Praet KM, Nersesian G, Montagner M. et al. Endoaortic balloon occlusion in minimally invasive mitral valve surgery. Multimed Man Cardiothorac Surg 2022; 2022 (02) 83-87
14 Paparella D, Guida P, Di Eusanio G. et al. Risk stratification for in-hospital mortality after cardiac surgery: external validation of EuroSCORE II in a prospective regional registry. Eur J Cardiothorac Surg 2014; 46 (05) 840-848
15 Kirmani BH, Mazhar K, Fabri BM, Pullan DM. Comparison of the EuroSCORE II and Society of Thoracic Surgeons 2008 risk tools. Eur J Cardiothorac Surg 2013; 44 (06) 999-1005 , discussion 1005
16 Carino D, Denti P, Ascione G. et al. Is the EuroSCORE II reliable in surgical mitral valve repair? A single-centre validation study. Eur J Cardiothorac Surg 2021; 59 (04) 863-868
17 ClinicalTrials.gov. MitraClip REPAIR MR Study. ClinicalTrials.gov identifier: NCT04198870. Updated December 22, 2022. Accessed May 1, 2022 at: https://clinicaltrials.gov/ct2/show/NCT04198870
18 ClinicalTrials.gov. Percutaneous or Surgical Mitral Valve Repair and Regurgitation for ≥60-Year olds (PRIMARY). ClinicalTrials.gov identifier: NCT05051033. Updated October 27, 2022. Accessed May 1, 2022 at: https://clinicaltrials.gov/ct2/show/NCT05051033
19 Hamandi M, Ryan WH, Grayburn PA, Huff E, Mallari L, Mack MJ. Misclassification of mitral valve disease and rate of surgical repair in The Society of Thoracic Surgeons database. Ann Thorac Surg 2020; 110 (02) 517-522
20 El-Eshmawi A, Castillo JG, Tang GHL, Adams DH. Developing a mitral valve center of excellence. Curr Opin Cardiol 2018; 33 (02) 155-161