Impact of Sub-Valvular Apparatus Preservation on Mitral Valve Replacement Outcomes
Author Information
Author(s): Christopher Rao, Jonathan Hart, Andre Chow, Fotios Siannis, Polyxeni Tsalafouta, Bari Murtuza, Ara Darzi, Frank C Wells, Thanos Athanasiou
Primary Institution: Imperial College London
Hypothesis
Does preservation of the sub-valvular apparatus during mitral valve replacement affect long-term survival and quality of life?
Conclusion
Long-term outcomes may be improved when the sub-valvular apparatus is preserved during mitral valve replacement.
Supporting Evidence
- Patients survive longer if the sub-valvular apparatus is preserved (65.7% vs 58.1% at 10 years).
- Quality adjusted life years gained over a 10 year period were greater after sub-valvular apparatus preservation (6.54 QALY vs 5.61 QALY).
- The superiority of preservation techniques was insensitive to patient age or model uncertainty.
Takeaway
Keeping certain parts of the heart intact during surgery can help patients live longer and feel better after getting a new heart valve.
Methodology
A microsimulation model was used to compare long-term survival and quality-adjusted life years following mitral valve replacement after conventional valve replacement and sub-valvular apparatus preservation.
Potential Biases
Potential biases due to reliance on non-randomised data and assumptions made about patient outcomes.
Limitations
The study lacks empirical data, particularly randomised data, in several important areas, and relied on non-randomised sources for some data.
Participant Demographics
The mean age of patients undergoing mitral valve replacement in the United Kingdom is approximately 62 years.
Statistical Information
P-Value
p<0.05
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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