Table 1. Patient Characteristics of Isolated MVRR for Primary Mitral Regurgitation by Quartiles of MVRR Volumea.
| Variable | Overall (N = 55 311) | Annual volume quartile | P value | |||
|---|---|---|---|---|---|---|
| Quartile 1 (0.80-10.80) (n = 1485) | Quartile 2 (10.88-23.27) (n = 4198) | Quartile 3 (23.45-46.36) (n = 10 247) | Quartile 4 (>46.55) (n = 39 381) | |||
| Age, median (IQR), y | 64 (56-73) | 65 (57-74) | 66 (57-74) | 66 (57-74) | 64 (55-73) | <.001 |
| Sex | ||||||
| Female | 23 764 (43.0) | 622 (41.9) | 1872 (44.6) | 4512 (44.0) | 16 758 (42.6) | .005 |
| Male | 31 547 (57.0) | 863 (58.1) | 2326 (55.4) | 5735 (56.0) | 22 623 (57.4) | |
| Race/ethnicity | ||||||
| Other | 808 (1.5) | 18 (1.2) | 46 (1.1) | 129 (1.3) | 615 (1.6) | <.001 |
| Native American | 131 (0.2) | 4 (0.3) | 14 (0.3) | 20 (0.2) | 93 (0.2) | |
| Asian | 1447 (2.6) | 39 (2.6) | 94 (2.2) | 253 (2.5) | 1061 (2.7) | |
| Hispanic | 1838 (3.3) | 75 (5.1) | 145 (3.5) | 372 (3.6) | 1246 (3.2) | |
| Black | 3945 (7.1) | 145 (9.8) | 319 (7.6) | 715 (7.0) | 2766 (7.0) | |
| White | 46 594 (84.2) | 1182 (79.6) | 3535 (84.2) | 8659 (84.5) | 33 218 (84.4) | |
| BMI, median (IQR)b | 26.3 (23.4-29.9) | 26.5 (23.5-30.3) | 27.0 (24.0-31.0) | 26.6 (23.6-30.5) | 26.2 (23.3-29.6) | <.001 |
| BSA, median (IQR),b m2 | 1.92 (1.74-2.09) | 1.92 (1.75-2.07) | 1.90 (1.80-2.10) | 1.93 (1.74-2.10) | 1.92 (1.74-2.09) | .008 |
| Diabetes | ||||||
| Insulin used | 1313 (2.4) | 43 (2.9) | 126 (3.0) | 291 (2.8) | 853 (2.2) | <.001 |
| No insulin used | 5231 (9.5) | 175 (11.8) | 467 (11.1) | 1105 (10.8) | 3484 (8.8) | |
| None | 48 743 (88.1) | 1267 (85.3) | 3603 (85.8) | 8849 (86.4) | 35 024 (88.9) | |
| Hypertension | ||||||
| Yes | 35 389 (64.0) | 1063 (71.6) | 2886 (68.7) | 6926 (67.6) | 24 514 (62.2) | <.001 |
| No | 19 899 (36.0) | 421 (28.4) | 1310 (31.2) | 3315 (32.4) | 14 853 (37.7) | |
| Chronic lung disease | ||||||
| Unknown severity | 757 (1.4) | 30 (2.0) | 68 (1.6) | 162 (1.6) | 497 (1.3) | <.001 |
| Severe | 1594 (2.9) | 65 (4.4) | 179 (4.3) | 353 (3.4) | 997 (2.5) | |
| Moderate | 2249 (4.1) | 100 (6.7) | 302 (7.2) | 495 (4.8) | 1352 (3.4) | |
| Mild | 5445 (9.8) | 197 (13.3) | 510 (12.1) | 1121 (10.9) | 3617 (9.2) | |
| None | 44 918 (81.2) | 1082 (72.9) | 3101 (73.9) | 8049 (78.5) | 32 686 (83.0) | |
| Dialysis | ||||||
| Yes | 662 (1.1) | 24 (1.6) | 70 (1.7) | 127 (1.2) | 441 (1.1) | .007 |
| No | 54 617 (98.7) | 1457 (98.1) | 4127 (98.3) | 10 106 (98.6) | 38 927 (98.8) | |
| Last creatinine level, median (IQR), mg/dLc | 0.9 (0.8-1.1) | 1.0 (0.8-1.1) | 1.0 (0.8-1.2) | 0.9 (0.8-1.1) | 0.9 (0.8-1.1) | <.001 |
| Immunocompromised | ||||||
| Yes | 1518 (2.7) | 34 (2.3) | 108 (2.6) | 237 (2.3) | 1139 (2.9) | .007 |
| No | 53 648 (97.0) | 1446 (97.4) | 4072 (97.0) | 9997 (97.6) | 38 133 (96.8) | |
| Peripheral vascular disease | ||||||
| Yes | 2028 (3.7) | 56 (3.8) | 180 (4.3) | 384 (3.7) | 1408 (3.6) | .12 |
| No | 53 213 (96.2) | 1426 (96.0) | 4003 (95.4) | 9846 (96.1) | 37 938 (96.3) | |
| CVD/CVA | ||||||
| CVD with no CVA | 2067 (3.7) | 54 (3.6) | 162 (3.9) | 439 (4.3) | 1412 (3.6) | .002 |
| CVD and CVA | 2043 (3.7) | 46 (3.1) | 182 (4.3) | 401 (3.9) | 1414 (3.6) | |
| No CVD | 51 104 (92.4) | 1379 (92.9) | 3845 (91.6) | 9378 (91.5) | 36 502 (92.7) | |
| Ejection fraction, median (IQR), %d | 60 (55-64) | 59 (50-63) | 59 (50-63) | 60 (53-63) | 60 (55-65) | <.001 |
| Atrial fibrillation type | ||||||
| Persistent | 9351 (16.9) | 269 (18.1) | 809 (19.3) | 2021 (19.7) | 6252 (15.9) | <.001 |
| Paroxysmal | 8272 (15.0) | 251 (16.9) | 671 (16.0) | 1723 (16.8) | 5627 (14.3) | |
| None | 37 529 (67.9) | 960 (64.6) | 2698 (64.3) | 6477 (63.2) | 27 394 (69.6) | |
| Congestive heart failure within 2 wk | ||||||
| Yes | 25 074 (45.3) | 668 (45.0) | 1786 (42.5) | 4463 (43.6) | 18 157 (46.1) | <.001 |
| No | 30 069 (54.4) | 814 (54.8) | 2393 (57.0) | 5760 (56.2) | 21 102 (53.6) | |
| NYHA classe | ||||||
| IV | 3766 (15.0) | 173 (25.9) | 379 (21.2) | 891 (20.0) | 2323 (12.8) | <.001 |
| III | 10 087 (40.2) | 300 (44.9) | 833 (46.6) | 1918 (43.0) | 7036 (38.8) | |
| II | 8775 (35.0) | 162 (24.3) | 444 (24.9) | 1285 (28.8) | 6884 (37.9) | |
| I | 1996 (8.0) | 26 (3.9) | 88 (4.9) | 272 (6.1) | 1610 (8.9) | |
| Mitral insufficiency | ||||||
| Severe | 51 756 (93.6) | 1403 (94.5) | 3965 (94.4) | 9642 (94.1) | 36 746 (93.3) | <.001 |
| Moderate to severe | 3555 (6.4) | 82 (5.5) | 233 (5.6) | 605 (5.9) | 2635 (6.7) | |
| Mitral valve procedure | ||||||
| Replacement | 10 619 (19.2) | 537 (36.2) | 1255 (29.9) | 2725 (26.6) | 6102 (15.5) | <.001 |
| Repair | 44 692 (80.8) | 948 (63.8) | 2943 (70.1) | 7522 (73.4) | 33 279 (84.5) | |
| Repair attempted before mitral valve replacementf | ||||||
| Yes | 2603 (24.5) | 140 (26.1) | 339 (27.0) | 648 (23.8) | 1476 (24.2) | .11 |
| No | 7940 (74.8) | 396 (73.7) | 907 (72.3) | 2070 (76.0) | 4567 (74.8) | |
| Operative approach | ||||||
| Minimally invasive thoracotomy | 16 199 (29.3) | 109 (7.3) | 539 (12.8) | 1965 (19.2) | 13 586 (34.5) | <.001 |
| Sternotomy | ||||||
| Partial | 1228 (2.2) | 8 (0.5) | 73 (1.7) | 216 (2.1) | 931 (2.4) | |
| Full | 37 804 (68.3) | 1366 (92.0) | 3580 (85.3) | 8054 (78.6) | 24 804 (63.0) | |
| Robotic technology assisted | ||||||
| Yes | 5756 (10.4) | 7 (0.5) | 96 (2.3) | 580 (5.7) | 5073 (12.9) | <.001 |
| No | 49 300 (89.1) | 1474 (99.3) | 4097 (97.6) | 9660 (94.3) | 34 069 (86.5) | |
| Cardiopulmonary bypass time, median (IQR), ming | 117 (90-151) | 126 (100-161) | 128 (100-162) | 125 (98-159) | 113 (87-147) | <.001 |
| Highest level of postoperative mitral insufficiencyh | ||||||
| Not documented | 1044 (2.2) | 38 (3.1) | 152 (4.4) | 266 (3.1) | 588 (1.7) | <.001 |
| Severe | 984 (2.1) | 67 (5.4) | 118 (3.4) | 292 (3.4) | 507 (1.5) | |
| Moderate | 602 (1.3) | 20 (1.6) | 75 (2.2) | 127 (1.5) | 380 (1.1) | |
| Mild | 3485 (7.4) | 113 (9.1) | 248 (7.1) | 696 (8.2) | 2428 (7.2) | |
| Trace/trivial | 13 657 (29.2) | 352 (28.5) | 915 (26.3) | 2563 (30.1) | 9827 (29.2) | |
| None | 26 157 (55.8) | 615 (49.8) | 1869 (53.6) | 4360 (51.2) | 19 313 (57.5) | |
| Mitral implant type | ||||||
| Annuloplasty | ||||||
| Band | 9764 (17.7) | 84 (5.7) | 301 (7.2) | 962 (9.4) | 8417 (21.4) | <.001 |
| Ring | 32 172 (58.2) | 782 (52.7) | 2434 (58.0) | 6113 (59.7) | 22 843 (58.0) | |
| Bioprosthesis | 8574 (15.5) | 397 (26.7) | 964 (23.0) | 2121 (20.7) | 5092 (12.9) | |
| Mechanical | 1842 (3.3) | 120 (8.1) | 256 (6.1) | 532 (5.2) | 934 (2.4) | |
| Atrial fibrillation surgical procedure | ||||||
| Yes | 16 406 (29.7) | 390 (26.3) | 1387 (33.0) | 3401 (33.2) | 11 228 (28.5) | <.001 |
| No | 38 795 (70.1) | 1093 (73.6) | 2805 (66.8) | 6838 (66.7) | 28 059 (71.3) | |
| STS estimated risk of mortality (IQR), % | 0.9 (0.5-2.0) | 1.2 (0.6-2.6) | 1.2 (0.6-2.5) | 1.1 (0.5-2.3) | 0.8 (0.4-1.9) | <.001 |
Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by the square of height in meters); BSA, body surface area; CVA, cerebrovascular accident; CVD, cerebrovascular disease; IQR, interquartile range; MVRR, mitral valve repair or replacement; NYHA, New York Heart Association; STS, Society of Thoracic Surgeons.
SI conversion factor: To convert creatinine to μmol/L, multiply by 88.4.
a
Unless otherwise indicated, data are expressed as number (percentage) of patients. Owing to missing data, totals for characteristics may not sum to number in column head and percentages may not total 100.
b
Includes 55 247 patients (1482 in quartile 1, 4192 in quartile 2, 10 234 in quartile 3, and 39 339 in quartile 4).
c
Includes 55 213 patients (1474 in quartile 1, 4186 in quartile 2, 10 223 in quartile 3, and 39 330 in quartile 4).
d
Includes 54 296 patients (1443 in quartile 1, 4105 in quartile 2, 9996 in quartile 3, and 38 752 in quartile 4).
e
Includes those with congestive heart failure within 2 weeks.
f
Includes those undergoing replacement.
g
Includes 55 177 patients (1478 in quartile 1, 4183 in quartile 2, 10 230 in quartile 3, and 39 286 in quartile 4).
h
Includes 46 847 patients (1235 in quartile 1, 3485 in quartile 2, 8523 in quartile 3, and 33 604 in quartile 4).