Description And Validation Of A Scoring System To Predict Mitral Valve Reparability

Abstract

Description And Validation Of A Scoring System To Predict Mitral Valve Repairability
D. Rose, J. Zacharias. Blackpool Victoria Hospital, Blackpool, United Kingdom,
Objective: The ACC/AHA guidelines recommend that mitral valve (MV) repair may be performed in asymptomatic patients with normal LV function if the likelihood of successful MV repair is greater than 90%. Unfortunately there is no objective system that predicts the likelihood of successful MV repair. We have developed a simple scoring system that calculates an additive score to correlate with ease of repair. Subsequently we have validated this in our practise, in over 250 consecutive patients.
Methods: We present a scoring system in which a score is allocated to the evaluation of three anatomic aspects of the MV: the annulus, the leaflets and the subvalvular apparatus. Each segment is analyzed on a Transoesophageal echocardiogram to detect those aspects that could make the repair more challenging. A score from 1 to 5 is allocated to each as they are evaluated, the magnitude of the score reflects the difficulty to attempt the repair.
A total of 264 consecutive mitral regurgitation patients referred to The Lancashire Cardiac centre, Blackpool, from November 2010, to March 2013, were retrospectively evaluated for inclusion in the present study. For each patient preoperative, intraoperative and post-operative transoesophageal echocardiograms were evaluated.
Results: Of the 264 patients reviewed, 193(68%) repairs and 71 (32%) replacements were performed in our hospital during that time frame. Patients with scores of 1 to 3 had a repair rate of 90% and more. Conversely as the score increased more valves got replaced. Patients with a score of 6 and above had a lower than 30% repair rate.
The corresponding ROC curve showed that the score has a good discrimination in our practise, AUC ROC = 0.88.
Conclusions: The scoring system described has a good correlation to repair rates in our centre. We use it currently to consent patients prior to surgery. We hope it can be used to refer a patient to surgery, with a high possibility of a valve repair, or continue with the clinical observation for those patients with a low probability of receiving a repair. It can also be used to refer a selected patient, depending on the score, directly to a reference centre where experienced surgeons can offer a higher repair percentage.