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(Circulation. 2003;108:II-90.)
© 2003 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Outcome of Mitral Valve Repair or Replacement: A Comparison by Propensity Score Analysis

Robert R. Moss, MD; Karin H. Humphries, PhD; Min Gao, PhD; Christopher R. Thompson, MD; James G. Abel, MD; Guy Fradet, MD; Brad I. Munt, MD

From the Division of Cardiology, St. Paul’s Hospital (R.R.M., C.R.T., B.I.M.); the Division of Cardiology, University of British Columbia & Center for Health Evaluation and Outcomes Sciences (K.H.H.); BC Cardiac Registries (M.G.); the Division of Cardiothoracic Surgery, St. Paul’s Hospital (J.G.A.); and the Division of Cardiothoracic Surgery, Vancouver Hospital (G.F.), Vancouver, BC, Canada.

Correspondence to Brad I. Munt, MD, Cardiac Echo Laboratory, 2350–1081 Burrard Street, St. Paul’s Hospital Vancouver, BC V6Z 1Y6. Phone: 604-806-8018, Fax: 604-806-8410, E-mail: bmunt{at}providencehealth.bc.ca

Background— There are no randomized trials comparing outcomes after mitral valve (MV) repair and replacement. Propensity scoring is a powerful tool that has the potential to reduce selection bias in nonrandomized studies.

Methods— From the BC Cardiac Registries, 2 060 patients presented for MV surgery, with or without CABG between 1991 and 2000. We then identified 322 MV repairs who were then matched by propensity score to an equal number of MV replacement patients. We compared survival and freedom from re-operation outcomes using Cox proportional hazards model analysis. Multivariable analysis was then used to compare outcomes in 358 MV repair patients with 352 MV replacement patients who had undergone chordal sparing surgery.

Results— The comparison groups generated using propensity scores were well balanced with respect to all collected baseline risk factors. Median follow-up time was 3.4 years. Patients undergoing MV repair had significantly improved survival (RR 0.46; 95% CI, 0.28 to 0.75) but a trend toward more re-operations (RR 2.11; 95% CI, 1.00 to 4.47) compared with patients undergoing replacement. Mitral valve repair patients still had better survival (RR 0.52; 95% CI, 0.32 to 0.85) compared with MV replacement patients who had undergone chordal sparing surgery.

Conclusion— We used propensity score methods to reduce selection bias in a population-based cohort of patients undergoing MV repair/replacement. Repair was associated with better survival, but a trend to increased re-operation.

Key Words: mitral valve • prosthesis • valvuloplasty • surgery