Clinical and Economic Impact of Preoperative Heart Failure in Patients Undergoing Degenerative Mitral Valve Repair

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Thoracic and Cardiovascular Surgery

Abstract

ABSTRACT Objective: To address limitations of registry-based outcome studies of mitral valve repair (MVr), we analyzed a comprehensive real-world dataset to assess the clinical and economic consequences of preoperative heart failure (pHF) among patients with degenerative mitral regurgitation (DMR). Methods: DMR patients (≥16 yr) undergoing MVr in 2017–2023 were identified from Optum’s Market Clarity database, which links electronic medical record (EMR) clinical details with longitudinal claims data. DMR was defined by diagnosis codes or physician documentation of mitral valve prolapse or chordal rupture. pHF was determined by diagnosis within 1-year preoperatively or at admission. Exclusions included other valve operations (except tricuspid repair), prior mitral intervention, LVAD, transplant, endocarditis, stenosis, end-stage renal disease, aortic aneurysm, cardiomyopathy and metastatic malignancy. Outcomes were stratified by pHF status. In-hospital cost, length of stay (LOS), ICU days, and prolonged ventilation were modeled using generalized linear models; mortality, readmission and reintervention were analyzed via Cox and competing risks regression, adjusting for demographics, comorbidities, and concomitant procedures. Results: Among 3,181 MVr patients, 1,149 (36%) had pHF. The mean age was 62 years and 68% held commercial insurance. pHF patients had more frequent comorbidities and concomitant operations (p< 0.01). After adjustment, pHF was associated with $20,021 higher hospitalization costs [$127,824 vs $107,803, ratio=1.19 (95% CI=1.14, 1.24), p< .01], longer LOS [10.0 vs 8.0 days, ratio=1.25 (1.20, 1.30), p< .01], and higher prolonged ventilation [10.4% vs 6.9%, ratio=1.50 (1.14, 1.97), p< .01]. Over 5 years, pHF patients had greater mortality [6.1% vs 1.9%, HR=1.71 (1.12, 2.61), p=.01] and cardiac readmission risk [49.2% vs 34.5%, HR=1.34 (1.17, 1.53), p< .01]. Cumulative costs exceeded those of non-pHF patients by $1,927 at 30 days [ratio=1.33 (1.19, 1.48), p< .01], $7,584 at 1 year [ratio=1.21 (1.11, 1.31), p< .01], and $30,944 at 5 years [ratio=1.21 (1.11, 1.31), p< .01]. Conclusions: pHF independently predicts worse short- and long-term outcomes and higher costs after MVr for DMR. Unlike registry analyses, this linked EMR-claims dataset captures real-world, longitudinal, and payer-relevant outcomes, highlighting the need for earlier surgical referral before HF onset to optimize clinical results, reduce readmissions and improve cost-effectiveness.

Volume

171

Issue

4 Suppl 1

First Page

S234

Last Page

S235

Comments

American Association for Thoracic Surgery (AATS) 106th Annual Meeting, May 2-26, 2026, Chicago, IL

DOI

10.1016/j.jtcvs.2026.03.299

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