AHA, Mitral Foundation urge mitral valve repair over replacement with recognition program

Research, along with guidelines from the American Heart Association® (AHA), indicates that patients who have primary mitral regurgitation would benefit from mitral valve repair rather than replacement. But over the last few decades, there has been great variance in the management of patients with the condition, with patients who are referred for surgery undergoing mitral valve replacement rather than repair.

“We are still seeing across the country too many patients who have repairable valves actually receiving mitral valve replacement,” said Dr. Robert Bonow, Professor of Cardiology at Northwestern University, member of the Mitral Foundation’s Scientific Advisory Board, and past President of the American Heart Association.

The American Heart Association recommends that patients who require surgery for mitral regurgitation be sent to centers expert in mitral valve repairs.¹ But up until recently there was no standard way that patients and physicians could identify the best surgeons and hospitals for mitral valve repair surgery.

“There is no question that the patients benefit when they are (treated by) more experienced surgeons and, frankly, the surgeons execute better surgery when they do more of them,” said Dr. David Adams, Professor and Chair of Cardiovascular Surgery at Mount Sinai Health System and President of the Mitral Foundation.

In an effort to offer patients and physicians a way to differentiate hospitals and surgeons who prioritize mitral valve reconstruction and have delivered high quality outcomes for the procedures, the American Heart Association and the Mitral Foundation have created a recognition program to identify, award and promote the best centers for mitral valve repair surgery.

“Let’s define and recognize centers that are truly expert in the surgical management of patients with mitral regurgitation because when it is done well, we return patients to a good quality of life with the lifespan of the average population,” Bonow said.

The Mitral Valve Repair Reference Center Award, which launched in late 2019, is intended to increase the number of patients who receive mitral valve repair rather than replacement when appropriate by offering them information about centers that are performing the procedure with high quality outcomes.

The program is aligned with others from the AHA which publishes clinical practice guidelines and scientific statements on various cardiovascular diseases as part of its Get With The Guidelines® program.

In order to be designated a Mitral Valve Repair Reference Center, facilities must demonstrate the standards and best practices developed by the Mitral Foundation’s Scientific Advisory Board, which is comprised of a group of physician leaders from the cardiology and cardiac surgery community.

Some of the standards outlined are:

• The center must have experienced cardiothoracic surgeons and structural heart cardiologists who perform mitral valve repair procedures with superior clinical outcomes.
• The center must have performed at least 50 index mitral valve repair procedures in the most recent year with a 95% success rate. 
• At least one surgeon at the center must have performed a minimum of 25 index mitral valve repair procedures in the most recent year or an average of 25 per year for the most recent two years with a 95% success rate. 
• Resources at the center must include advanced imaging, advanced circulatory management, electrophysiology testing, 24/7 care, at least one reference surgeon and clinicians with level three training in echocardiography.

The volume of mitral valve repair procedures was selected as the baseline criterion to be designated a Mitral Valve Repair Reference Center because of the research evidence demonstrating the correlation between higher volume and better outcomes.² In a retrospective analysis of degenerative mitral valve operations in New York, researchers found that when surgeons did more than 25 degenerative mitral valve repairs in one year, there was a decreased  risk of mortality and reoperation after one year.

Another study also found that 30-day operative mortality was lower at hospitals that performed at least 50 mitral valve repair surgeries a year, which is why it’s a criterion to be designated a Mitral Valve Repair Reference Center.³

“Volume is not everything. You can have superb results and be a lower volume center, and even a higher volume center may not have good outcomes when we start talking about successful repair and durability,” Bonow said. “We would like to see what our colleagues say and what they have been doing by applying for the program.” Adams added, “Those Centers which perform a sufficient number of repairs and qualify to apply for recognition must meet rigorous outcomes criteria for repair rates, mortality and durability.”

Since the program launched, 20 centers across the U.S. have been recognized as a Mitral Valve Repair Reference Center. The full list of centers can be found at http://www.mitralfoundation.org/reference-center-award/find-a-center. 

The ultimate goal for the Mitral Valve Repair Reference Center Award program is to serve as a guide for patients and referring physicians to identify the best teams for mitral valve repair surgery near them. While there are a few highly regarded cardiac centers in the U.S. that are well-known for mitral valve repairs, there are also cardiac teams performing high-quality mitral valve repair surgery that local communities and referring physicians need to be aware of.

“Our ambition for this program is to identify the regional centers around the country that we may not know about,” Adams said. “That is going to raise the bar for patients.”

Applications for the Mitral Valve Repair Reference Center Award are currently being accepted. Click here for more information about how to apply.