Mitral valve surgery earns distinction for cardiac program

The UW Medicine Heart Institute in Seattle is the nation’s newest Mitral Valve Repair Reference Center, becoming the only such site in the Pacific Northwest.

The distinction was formalized today by the American Heart Association and the Mitral Foundation. It recognizes UW Medicine’s record of case volumes and superior clinical outcomes over the past three years among patients who underwent surgery to repair degenerative mitral valve disease.

“The focus is to maximize durable surgical repair in patients whose main problem is primary mitral valve abnormalities, not secondary pathologies,” said Dr. Gabriel Aldea, a professor of surgery at the University of Washington School of Medicine.

Surgical repairs have been the gold standard of care for decades. With advanced techniques performed by experienced hands, the success rate is better than 95% and mortality rate is less than 1%, Aldea said. Patients who have a successful surgical mitral valve repair often regain access to a normal life expectancy without activity restrictions.

To expect that quality of result, patients should seek care at a center with high volumes of those repairs and outcomes verified by an outside party as successful and durable, he added.

Aldea is UW Medicine’s chief of cardiac surgery and performed most of the healthcare system’s 61 mitral-valve reconstructions in 2021. A “center” designation requires 50 such procedures per year for three consecutive years, a corresponding valve-repair rate of 95% or better, and a patient-mortality rate of less than 1%. The designation must be earned annually.

The designation applies to open surgeries that repair the existing mitral valve. Evidence shows these repairs have better durability and are associated with better patient survival than surgically placed biological or mechanical replacement valves as well as catheter-based valve replacements or repairs.

“Two decades’ worth of information shows us that valve repairs, no matter how complex, are way better than valve replacements. When you save someone's original valve, there is a 90% likelihood that they will require no further intervention during their lifetime,” Aldea said.

Although most mitral-valve repairs in the United States are straightforward procedures to resolve leaks, Aldea said 70% of those cases referred to UW Medicine involve complex anatomies—making the new designation a more notable achievement.

“We get referrals from community cardiologists and surgeons who are unsure whether they can perform the needed repair,” Aldea said, identifying complexities such as resurfacing and moving valve leaflets, which are routine for his team.

It also is the case, he said, that community cardiologists may direct patients with complex anatomies to receive mechanical replacements without considering the possibility of a surgical repair. 

The Mitral Valve Repair Reference Center Award is based on standard-care guidelines last updated in 2020. A contributing author on the panel that wrote the update is Dr. Catherine Otto, a UW professor of cardiology.

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