Few Patients With Functional MR Are Treated Surgically: Duke Database Results
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20090417 Few Patients With Functional MR Are Treated Surgically: Duke Database Results Mitchell W. Krucoff MD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical Research Institute
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Few Patients With Functional MR Are Treated Surgically: Duke Database Results. Mitchell W. Krucoff MD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical Research Institute. Conflict of Interest. - PowerPoint PPT Presentation
Transcript of Few Patients With Functional MR Are Treated Surgically: Duke Database Results
20090417
Few Patients With Functional MR Are Treated Surgically:Duke Database Results
Mitchell W. Krucoff MD
FACC, FAHA, FSCAIProfessor of Medicine / Cardiology
Duke University Medical CenterDirector, Cardiovascular Devices Unit
Duke Clinical Research Institute
20090417
Conflict of Interest
Research grants, consulting, advisory: Abbott Vascular Cardiac Dimension Medtronic St. Jude
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Acknowledgement
Zainab Samad, Eric Yow, Linda K Shaw, Hussein R Al-Khalidi, Kristine Arges, John H
Toptine, Andrew Wang, James G Jollis, Eric J Velazquez
AHA 2011
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Background
While systematic “real world” data exist on patients with MR undergoing surgery (Society of Thoracic Surgery=STS database), there is far less information on the incidence and outcomes of MR patients managed medically.
While valve repair/replacement is accepted therapy for degenerative MR, the value of such interventions in functional MR patients is unknown
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Duke Cardiovascular Database (1995-2012)
126,796 Unique Patients Echo + Cardiac CatheterizationN=30,848
Echo onlyN=74,367
Cardiac Catheterization onlyN=21,579
Cath within 1 yr N=27,045
Moderate or Severe MR
Cath outside 1 yrN=3,803
N=3,920
N= 280
N=5,109
N= 242
9,551 (7.5%) with Moderate or Severe MR
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Treatments Received
Medical Therapy %
71 68 53 <0.0001
Valve within 1 yr
8 17 42 <0.0001
CABG within 1 yr
13 14 15 0.4272
Mild MR Moderate MR Severe MR P valueN 8172 2819 1136
FMR, % 92 85 67 <0.0001
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Unadjusted Survival by MR Severity*
*censored at surgery
0 2 4 6 8 10 12 14 160
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
None/Trivial MRMild MRModerateSevere MR
Years
Surv
ival
Pro
babi
lity
p<.0.0001
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Survival: Moderate or Severe MR by Treatment – Unadjusted*
0 2 4 6 8 10 12 140
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
MedicalIsolated CABGIsolated ValveCABG + Valve
Years
p<0.0001
Sur
viva
l Pro
babi
lity
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Results
Echo and Cardiac Catheterization within 1 yr
+ Moderate or Severe MR N = 3920
Non-High RiskN= 1666
High RiskN= 2254
High Risk Criteria:• STS score ≥ 12%• Age > 75 + EF <40%• Functional MR + EF
<40%• ≥ 2 prior chest surgeries• Prior chest surgery + EF
<35% + Cr > 2.5 mg/dL• Age > 75 + prior chest
surgery + Cr > 2.5 mg/dL• Hepatic cirrhosis• Dialysis• Chronic lung disease• Prior stroke• Prior CABG
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Survival: Moderate or Severe MR by Risk Group- Unadjusted*
0 2 4 6 8 10 12 140
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Not High Risk
High Risk
Years
Surv
ival
Pro
babi
lity
p<0.0001
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Survival: High Risk Moderate or Severe MR by Treatment
0 2 4 6 8 10 12 140
0.2
0.4
0.6
0.8
1
MedicalIsolated ValveCABG +/- Valve
YearsSurv
ival
Pro
babi
l-ity
p=.0299
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Treatment of Severe FMR:Observations From Longitudinal Data
Valve surgery is rare in all FMR, mild, moderate, severe
Combined high risk and moderate/severe MR outcomes are poor with and without surgery
Longitudinal natural history models of FMR patients may be helpful in percutaneous MV study designs
