Advanced risk score predicts long-term survival after mitral valve surgery
The Society of Thoracic Surgeons (STS) Risk Calculator can accurately predict a patient’s five-year mortality risk before they undergo mitral valve replacement (MVR), according to new research published in The Annals of Thoracic Surgery.[1] This helps care team identify patients who may benefit from alternative treatment strategies.
“MVR is recognized for its significant operative risks, leading many high-risk patients to be excluded from surgical management,” wrote first author Matthew Kazaleh, DO, MSc, a researcher with the department of cardiac surgery at the University of Michigan in Ann Arbor, and colleagues. “As transcatheter therapies advance, the importance of surgical risk stratification and patient selection has grown significantly.”
While the STS Risk Calculator is regularly used to predict short-term mortality, the team behind this analysis hoped to learn more about its ability to anticipate long-term risks. The group explored data from nearly 1,500 MVR patients treated at a single high-volume facility from 2010 to 2023. Patients undergoing concomitant aortic valve and coronary artery bypass procedures were excluded. The final study cohort included 855 patients with a median age of 64 years old. While 63.2% of patients were women, 81.6% were white. In addition, 75.5% of MVR operations were elective, 23% were urgent, 1.4% were emergent and the final 0.1% were emergent salvage.
While an STS Predicted Risk of Mortality (STS PROM) of less than 3% was linked to low-risk patients, an STS PROM between 3% and 6% was linked to intermediate-risk patients. An STS PROM of more than 6%, meanwhile, was linked to high-risk patients.
Overall, the mean STS PROM for the entire study population was 5.9%. As one may expect, comorbidities such as hypertension, diabetes, previous myocardial infarction and heart failure were most common among high-risk patients.
Survival five years after MVR was 90.8% for low-risk patients, 75.5% for intermediate-risk patients and 56.4% for high-risk patients, suggesting that the STS PROM is an effective way for clinicians to anticipate how a patient may respond to treatment. Preoperative dialysis, hypertension and urgent status were all associated with worse long-term survival odds for patients undergoing MVR.
“These findings collectively offer more refined risk-stratification criteria to help identify patients who are candidates for isolated mitral valve replacement and those who may be better suited pursuing alternative therapies,” the authors wrote.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.