New Risk Assessment Model Assesses Treatment Options for Patients With MR

January 18, 2023—The Society of Thoracic Surgeons (STS) announced the development of a new risk model calculator based on contemporary data that will provide health care professionals with a much more accurate assessment of the risk of mitral repair individualized to their patients’ medical profiles.

According to STS, leading cardiology and cardiothoracic surgical investigators analyzed recent national data to assess the outcomes and risk of mitral valve repair for primary mitral regurgitation (MR).

Information from the STS Adult Cardiac Surgery Database identified 53,462 patients who underwent planned surgical mitral valve repair for primary MR between 2014 and 2020.

Vinay Badhwar, MD, et al published the findings online ahead of print in both The Annals of Thoracic Surgery and Journal of the American College of Cardiology. Dr. Badhwar is Professor of Cardiovascular and Thoracic Surgery from the West Virginia University in Morgantown, West Virginia. Robert Habib, PhD, from the STS Analytic and Research Center in Chicago, Illinois, served as lead statistician for the team.

As summarized in the STS press release, the investigators found that there was an increasing frequency of minimally invasive transcatheter edge-to-edge repair, including procedures performed robotically, and that the rate of successful repair has now reached > 90% in the United States. Most importantly, the risk of mortality after the procedure was extremely rare across nearly all age ranges.

These data were used to develop a novel risk model for predicting 30-day outcomes based on a patient’s health condition. The model formed the basis for a new online risk calculator to assist health care providers to estimate the risks for their patients that will soon be available on the STS website, https://www.sts.org.

“The mortality risk model had excellent discrimination and calibration and confirmed very low mortality risk for isolated mitral valve repair,” reported Dr. Habib in the STS press release. “For the vast majority of patients, the risk of death related to this procedure was less than 1%.”

Dr. Badhwar added, “We have two options to treat primary mitral valve regurgitation. The historical standard has been surgical repair, but we also have FDA-approved transcatheter devices for minimally invasive mitral valve repair that have encouraging results, particularly in high-risk patients with primary mitral regurgitation.”

Dr. Badhwar continued, “Past perceptions of the risk of surgery and repair rates based on older risk models may have influenced the design of two clinical trials to explore transcatheter therapy in lower risk older individuals. The finding of 90% successful surgical repair with < 1% mortality now achieved in the United States sets the outcome bar fairly high when considering alternative therapies to surgery. We hope this information will help physicians and patients make more informed decisions regarding treatment, as well as to inform the optimal design of future trials in the field.”