Which Patients Are Candidates for Minimally Invasive Mitral Valve Surgery?　― Establishment of Risk Calculators Using National Clinical Database

Background:Although minimally invasive mitral valve surgery via a right minithoracotomy (MICS-mitral) is widely performed, no tool to evaluate its risk has been reported. We sought to establish MICS-mitral risk calculators using a national clinical database for selection of appropriate patients.Meth...

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Bibliographic Details
Published in:Circulation Journal 2019/07/25, Vol.83(8), pp.1674-1681
Main Authors: Nishi, Hiroyuki, Miyata, Hiroaki, Motomura, Noboru, Takahashi, Toshiki, Sawa, Yoshiki, Takamoto, Shinichi, on behalf of the Japan Cardiovascular Surgery Database Organization
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Cardiac Surgical Procedures - adverse effects
Cardiac Surgical Procedures - mortality
Clinical Decision-Making
Databases, Factual
Decision Support Techniques
Female
Heart Valve Diseases - diagnostic imaging
Heart Valve Diseases - mortality
Heart Valve Diseases - physiopathology
Heart Valve Diseases - surgery
Hemodynamics
Hospital Mortality
Humans
Japan
Male
Middle Aged
Minimally invasive cardiac surgery
Mitral valve
Mitral Valve - diagnostic imaging
Mitral Valve - physiopathology
Mitral Valve - surgery
Patient Selection
Postoperative Hemorrhage - mortality
Postoperative Hemorrhage - surgery
Predictive Value of Tests
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Risk models
Stroke - etiology
Stroke - mortality
Thoracotomy - adverse effects
Thoracotomy - mortality
Time Factors
Treatment Outcome
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Summary:Background:Although minimally invasive mitral valve surgery via a right minithoracotomy (MICS-mitral) is widely performed, no tool to evaluate its risk has been reported. We sought to establish MICS-mitral risk calculators using a national clinical database for selection of appropriate patients.Methods and Results:Between 2008 and 2015, 3,240 patients (mean age 59±14 years, males 1,950) underwent a MICS-mitral procedure in Japan and were registered in a national clinical database. We examined mortality and composite outcome (operative mortality, stroke, reoperation for bleeding) using multivariate analysis, then developed a risk calculator for each using stepwise analysis. Operative mortality was 1.1% and the composite outcome rate was 5%. In multivariate analysis, risk factors for operative mortality were shown to be age, respiratory dysfunction, thoracic aortic disease, myocardial infarction, body mass index >30, NYHA class IV, moderate or severe aortic regurgitation, mitral valve replacement, multiple valve surgery, and annual cases
ISSN:1346-9843
1347-4820
1347-4820
DOI:10.1253/circj.CJ-19-0175