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Few Patients With Functional MR Are Treated Surgically: Duke Database Results

Few Patients With Functional MR Are Treated Surgically: Duke Database Results. Mitchell W. Krucoff MD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical Research Institute. Conflict of Interest.

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Few Patients With Functional MR Are Treated Surgically: Duke Database Results

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  1. Few Patients With Functional MR Are Treated Surgically:Duke Database Results Mitchell W. KrucoffMD FACC, FAHA, FSCAI Professor of Medicine / Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical Research Institute

  2. Conflict of Interest Research grants, consulting, advisory: • Abbott Vascular • Cardiac Dimension • Medtronic • St. Jude

  3. Acknowledgement ZainabSamad, Eric Yow, Linda K Shaw, Hussein R Al-Khalidi, Kristine Arges, John H Toptine, Andrew Wang, James G Jollis, Eric J Velazquez AHA 2011

  4. Background • While systematic “real world” data exist on patients with MR undergoing surgery (Society of Thoracic Surgery=STS database), there is far less information on the incidence and outcomes of MR patients managed medically. • While valve repair/replacement is accepted therapy for degenerative MR, the value of such interventions in functional MR patients is unknown

  5. Duke Cardiovascular Database (1995-2012) 126,796 Unique Patients Moderate or Severe MR Echo + Cardiac Catheterization N=30,848 Cath within 1 yr N=27,045 N=3,920 Cath outside 1 yr N=3,803 N= 280 Echo only N=74,367 N=5,109 Cardiac Catheterization only N=21,579 N= 242 9,551 (7.5%) with Moderate or Severe MR

  6. Treatments Received

  7. Unadjusted Survival by MR Severity* *censored at surgery

  8. Survival: Moderate or Severe MR by Treatment – Unadjusted* Survival Probability

  9. Results Echo and Cardiac Catheterization within 1 yr + Moderate or Severe MR N = 3920 • High Risk Criteria: • STS score ≥ 12% • Age > 75 + EF <40% • Functional MR + EF <40% • ≥ 2 prior chest surgeries • Prior chest surgery + EF <35% + Cr > 2.5 mg/dL • Age > 75 + prior chest surgery + Cr > 2.5 mg/dL • Hepatic cirrhosis • Dialysis • Chronic lung disease • Prior stroke • Prior CABG Non-High Risk N= 1666 High Risk N= 2254

  10. Survival: Moderate or Severe MR by Risk Group- Unadjusted*

  11. Survival: High Risk Moderate or Severe MR by Treatment

  12. Treatment of Severe FMR:Observations From Longitudinal Data • Valve surgery is rare in all FMR, mild, moderate, severe • Combined high risk and moderate/severe MR outcomes are poor with and without surgery • Longitudinal natural history models of FMR patients may be helpful in percutaneous MV study designs

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