Mitral Valve Repair: “An Opportunity for Quality Improvement”

Even in low-volume VA centers, mitral valve repair outcomes best replacement.

A large multi-center study presented at the 96th American Association for Thoracic Surgery Annual Meeting followed trends in mitral valve (MV) surgeries in the Veterans Administration Health System from 2001-2013 and provided further evidence to support the use of mitral valve repair over mitral valve replacement in patients with degenerative MV disease.

"MVRepair has a greater short-term protective effect against mortality than MVReplace has in patients with primary degenerative MR," write the authors. "Despite this survival advantage, the rate of MVRepair is low at some centers; therefore, there is clearly an opportunity for quality improvement."

Beyond a survival advantage, mitral valve repair was also found to result in fewer complications and shorter hospital stays.

Is that success dependent on volume? Not necessarily.

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One simple procedural change reduces mortality in the cath lab

An international study published mid-March in the Lancet showed that using the wrist as an access point for heart catheterization reduced bleeding and lowered mortality rates as opposed to using the groin as an access point.

While previous studies have demonstrated that wrist access reduces incidents of bleeding, this is the first to demonstrate the connection with incidents of mortality.

The change lowers mortality at no additional cost beyond necessary additional training and expertise---insertion through the wrist is more technically demanding than insertion through the groin, as the artery is smaller.