--- title: "Mitral valve operations: standard and smaller incisions. | Sutter Health" description: "Mortality rate for MV operations is concentrated among a few diagnoses. In some patients, surgery may be approached safely through smaller incisions." url: "https://www.sutterhealth.org/research/publications/mitral-valve-operations-std-smaller-incisions-1055312446" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Mitral valve operations: standard and smaller incisions. # Mitral valve operations through standard and smaller incisions. Gaudiani VA, Grunkemeier GL, Castro LJ, Fisher AL, & Wu Y. _Heart Surg Forum. 7(4):E337-42._ 2004-01-01 ## Abstract OBJECTIVE: Evaluate the operative results of mitral valve repair (MVV) and mitral valve replacement (MVR) performed through standard and smaller incisions. METHODS: From January 1997 through December 2002, 821 consecutive patients underwent mitral valve operation. Of these procedures, 475 were MVV and 346 were MVR. A logistic regression model was developed to identify the risk factors for early mortality and to evaluate the effect of replacement versus repair and standard versus small incision. RESULTS: Replacement patients were older, more likely New York Heart Association (NYHA) class III or IV, more likely female, and had more frequent previous median sternotomy and stroke (all P <.05). The mitral diagnoses in the 2 groups were markedly different. Prolapse and ischemia dominated the repairs, whereas calcific and rheumatic diagnoses required replacement. There were 667 concomitant procedures performed on these patients, most commonly coronary artery bypass graft (229), aortic valve replacement (170), maze (79), and tricuspid valve (TV) repair/replacement (73). Thirty-three patients (4.0%) died in the postoperative period, 2.3% after repair and 6.4% after replacement ( P <.01). Endocarditis (4/17), calcific disease (7/73), and ischemic disease (9/121) accounted for 26% of patients and 60% of deaths. Multivariate regression analysis identified NYHA class, emergent status, concomitant TV operation, and history of renal failure, but not repair versus replacement, as independent risk factors predicting mortality. We estimated that 356 of the 821 patients (43%) were candidates for small-incision operations, the others were excluded by the need for concomitant procedure or other cause. A total of 205/356 (57%) actually underwent small-incision operations, all with central cannulation and standard techniques. From 1997-1999, 32% of eligible patients were so treated, but from 2000-2002, with increasing surgeon experience, this percentage rose significantly to 71% ( P <.01). Eligible patients who underwent small-incision operation were younger and had lower NYHA classifications, lower preoperative creatinine, and shorter length of stay (all P <.01) than those who had standard incisions. Cross-clamp time, perfusion time, and mortality rate were not significantly different. CONCLUSIONS: The mortality rate for MV operations is concentrated among a few diagnoses. In some patients surgery may be approached safely through smaller incisions without introducing new elements of operative risk. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/15454389) ## Research topics - [Cardiovascular Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Cardiovascular+Diseases%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [3D image-based navigators for coronary MR angiography.](https://www.sutterhealth.org/research/publications/3d-image-navig-ht-mr-angiography-1055312459) Addy NO, Ingle RR, Luo J, Baron CA, Yang PC, Hu BS, Nishimura DG. Magn Reson Med. doi: 10.1002/mrm.26269. \[Epub ahead of print\] 2016 May 13 - Publication ### [Nonrigid motion correction with 3D image-based navigators for coronary MR angiography.](https://www.sutterhealth.org/research/publications/motion-correction-3d-image-navig-ht-mra-1055312449) Luo J, Addy NO, Ingle RR, Baron CA, Cheng JY, Hu BS, Nishimura DG. Magn Reson Med. doi: 10.1002/mrm.26273. \[Epub ahead of print\] 2016 May 13 - Publication ### [Rapid single-breath-hold 3D late gadolinium enhancement cardiac MRI using a stack-of-spirals acquisition.](https://www.sutterhealth.org/research/publications/rapid-3d-gadolinium-enhancemt-cardiac-mri-1055312461) Shin T, Lustig M, Nishimura DG, Hu BS. J Magn Reson Imaging. 40(6):1496-502. doi: 10.1002/jmri.24494. Epub 2013 Nov 15. J Magn Reson Imaging. 40(6):1496-502. doi: 10.1002/jmri.24494. Epub 2013 Nov 15. Send to: 2014 Dec 02 - Publication ### [Antiplatelet therapy use after discharge among acute myocardial infarction patients with in-hospital bleeding.](https://www.sutterhealth.org/research/publications/antiplatelet-tx-post-discharge-ami-pts-1055312976) Wang TY, Xiao L, Alexander KP, Rao SV, Kosiborod MN, Rumsfeld JS, Spertus JA, Peterson ED. Circulation. 118(21):2139-45. doi: 10.1161/CIRCULATIONAHA.108.787143. Epub 2008 Nov 3. 2008 Nov 18 - Publication ### [High-resolution variable-density 3D cones coronary MRA.](https://www.sutterhealth.org/research/publications/high-resolution-vary-density-3d-cones-coronary-mra-1055312425) Addy NO, Ingle RR, Wu HH, Hu BS, Nishimura DG. Magn Reson Med. 74(3):614-21. doi: 10.1002/mrm.25803. Epub 2015 Jul 14. 2015 Sep 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/mitral-valve-operations-std-smaller-incisions-1055312446#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Mitral valve operations: standard and smaller incisions."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/mitral-valve-operations-std-smaller-incisions-1055312446#medicalscholarlyarticle","name":"Mitral valve operations through standard and smaller incisions.","headline":"Mitral valve operations: standard and smaller incisions.","abstract":"OBJECTIVE: Evaluate the operative results of mitral valve repair (MVV) and mitral valve replacement (MVR) performed through standard and smaller incisions. METHODS: From January 1997 through December 2002, 821 consecutive patients underwent mitral valve operation. Of these procedures, 475 were MVV and 346 were MVR. A logistic regression model was developed to identify the risk factors for early mortality and to evaluate the effect of replacement versus repair and standard versus small incision. RESULTS: Replacement patients were older, more likely New York Heart Association (NYHA) class III or IV, more likely female, and had more frequent previous median sternotomy and stroke (all P \u003c.05). The mitral diagnoses in the 2 groups were markedly different. Prolapse and ischemia dominated the repairs, whereas calcific and rheumatic diagnoses required replacement. There were 667 concomitant procedures performed on these patients, most commonly coronary artery bypass graft (229), aortic valve replacement (170), maze (79), and tricuspid valve (TV) repair/replacement (73). Thirty-three patients (4.0%) died in the postoperative period, 2.3% after repair and 6.4% after replacement ( P \u003c.01). Endocarditis (4/17), calcific disease (7/73), and ischemic disease (9/121) accounted for 26% of patients and 60% of deaths. Multivariate regression analysis identified NYHA class, emergent status, concomitant TV operation, and history of renal failure, but not repair versus replacement, as independent risk factors predicting mortality. We estimated that 356 of the 821 patients (43%) were candidates for small-incision operations, the others were excluded by the need for concomitant procedure or other cause. A total of 205/356 (57%) actually underwent small-incision operations, all with central cannulation and standard techniques. From 1997-1999, 32% of eligible patients were so treated, but from 2000-2002, with increasing surgeon experience, this percentage rose significantly to 71% ( P \u003c.01). Eligible patients who underwent small-incision operation were younger and had lower NYHA classifications, lower preoperative creatinine, and shorter length of stay (all P \u003c.01) than those who had standard incisions. Cross-clamp time, perfusion time, and mortality rate were not significantly different. CONCLUSIONS: The mortality rate for MV operations is concentrated among a few diagnoses. In some patients surgery may be approached safely through smaller incisions without introducing new elements of operative risk.","description":"Mortality rate for MV operations is concentrated among a few diagnoses. 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