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Thorac Cardiovasc Surg
DOI: 10.1055/a-2650-6994
Original Cardiovascular

Validation of a Risk Calculator for Surgical Repair of Primary Mitral Regurgitation

Serdar Akansel 
1   Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
2   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Martina Dini
1   Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
2   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Simon H. Sündermann
1   Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
2   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
3   German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
,
Stephan Jacobs
1   Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
2   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
3   German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
,
Volkmar Falk
1   Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
2   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
3   German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
4   ETH Zurich, Department of Health Sciences and Technology, Zurich, Switzerland
,
Jörg Kempfert
1   Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
2   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
3   German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
,
Markus Kofler
1   Deutsches Herzzentrum der Charité, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany
2   Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
3   German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
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Abstract

Objective

Risk estimation for cardiac procedures is essential for clinical decision-making. The aim of the study is to validate the recently introduced Society of Thoracic Surgeons (STS) risk score model for mitral valve repair (MVr) in degenerative mitral regurgitation (DMR) by investigating a large cohort undergoing minimally invasive MVr (MI-MVr).

Methods

A total of 1,081 consecutive patients with DMR undergoing non-emergent MI-MVr were retrospectively analyzed. The primary study endpoint was 30-day all-cause mortality (OM), while secondary endpoints were major morbidity and mortality (MM) and conversion-to-replacement (CONV). Predictive discrimination and calibration of the models were measured using receiver operating characteristic (ROC) analysis.

Results

A 30-day mortality of 0.55% was observed in the study cohort. All risk scores were significantly higher in non-survivors. Like existing risk models, the intention-to-treat-OM (ITT-OM) model was predictive for OM (OR: 2.078, 95% CI: 1.324–3.621; p = 0.001), but its discriminatory ability was limited based on ROC analysis. EuroSCORE II showed the best discriminatory performance for mortality among the investigated models. Furthermore, second cross-clamping and CONV were independent predictors of OM (OR: 26.2, 95% CI: 4.3–160.0; p < 0.001 and OR: 12.8, 95% CI: 1.8–89.2; p = 0.010). The ITT-MM and ITT-CONV models demonstrated an acceptable discriminatory ability for predicting operative MM and CONV.

Conclusion

The ITT-based risk model was validated in our study cohort undergoing MI-MVr for DMR, showing only limited discriminatory performance for mortality, while the EuroSCORE II demonstrated better discrimination for mortality despite systematic overestimation. This is the first report validating the recently introduced model. However, further studies with larger cohorts are needed to overcome the limitations of the present study.

Keywords

mitral valve surgery - minimally invasive mitral valve repair - outcomes

Note

This report has not been published elsewhere and is not currently being considered for publication elsewhere. The paper has been selected by the Programme Committee as an oral presentation to be presented at the 2025 Annual Meeting of DGTHG.




Publication History

Received: 25 March 2025

Accepted: 07 July 2025

Article published online:
18 July 2025

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