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Original Articles: Adult Cardiac

Invited Commentary

Cardiothoracic Surgery, New York University Medical Center, 530 First Ave, Ste 9-V, New York, NY 10016

(Email: alfred.culliford{at}med.nyu.edu).

The outcome of patients undergoing mitral valve repair in the United States was recently reported by Gammie and colleges [1] in this journal. The analysis was based on the Society of Thoracic Surgeons database of 910 hospitals. During an 8-year period, the rate of repair increased from 51% to 69% in more than 28,000 patients. The reported operation mortality was 1.2% overall, but only 0.6% for class I patients undergoing repair.

The above article by Suri and colleges [2] is an important analysis about how the repairs may be accomplished. The outcomes of two experienced and committed teams in Philadelphia and Minnesota were compared. A standard sternotomy was used in the latter, whereas a small thoracotomy, groin cannulation, endoaortic occlusion with cardioplegia administered, and thorascopic illumination and visualization was used in the former.

More then 350 patients were treated in each center over several years. All patients had degenerative valve disease requiring leaflet(s) repair and ring insertion. Careful outcome analysis revealed remarkable similarity. As anticipated, pump time and cross-clamp time were longer in the port-access approach (141 and 104 vs 33 and 24 minutes), and port patients were extubated sooner (5 vs 11 hours). No other major differences were encountered. In the entire series of 750 patients, only 2 early deaths and 5 deep wound infections (4 port and 1 sternotomy) were noted. Patients in both groups had nearly comparable operative outcomes, but long-term follow-up was not provided.

This article deserves careful reading because highly skilled academic surgical teams collegially compared outcomes. Both approaches yielded excellent results despite different surgical platforms. The inquisitive reader will wonder:

1 Is the port approach associated with a steep learning curve, particularly if the volume of mitral repair is not robust?

2 Should cost of the procedure be part of the equation considering the equality of outcome?

3 In academic settings, where many of the surgeons of the future are trained, how teachable are alternative approaches?

4 Should these results be viewed as a call for earlier operations in patients with mitral insufficiency to preserve cardiac function and foster vigorous life styles and not as a platform for misleading and untruthful promotionals and Web sites?

	References

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1. Gammie JS, Sheng S, Griffith BP, et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Database Ann Thorac Surg 2009;87:1431-1439.[Abstract/Free Full Text]
2. Suri RM, Schaff HV, Meyer SR, Hargrove III WC. Thoracoscopic versus open mitral valve repair: a propensity score analysis of early outcomes Ann Thorac Surg 2009;88:1185-1190.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alfred T. Culliford Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Culliford, A. T. Search for Related Content PubMed PubMed Citation Articles by Culliford, A. T. Related Collections Minimally invasive surgery Valve disease Related Article