Mitral Valve Repair is Underused in Patients with Hypertrophic Obstructive Cardiomyopathy


  • Christina M. Vassileva
  • Theresa Boley
  • Stephen Markwell
  • Stephen Hazelrigg



Background: The optimal surgical approach for patients with hypertrophic obstructive cardiomyopathy (HOCM) with concomitant mitral valve (MV) regurgitation has remained controversial. The purpose of this study was to use the largest all-payer database in the United States to examine the strategy most commonly used for the correction of mitral valve pathology in the setting of HOCM.

Methods: The Nationwide Inpatient Sample (NIS) database was searched from 2005 to 2008 to identify patients with a diagnosis of HOCM (ICD-9-CM code 425.1) who underwent MV repair (ICD-9-CM code 35.12) or replacement (ICD-9-CM codes 35.23 and 35.24). HOCM patients who underwent MV repair and those who underwent MV replacement were compared with respect to baseline characteristics, repair rates, hospital mortality, and length of stay (LOS).

Results: MV repair was performed in 17.2% of cases (219/1255). Repair rates did not show a significantly increasing trend over time (P = .1419). The median LOS was significantly longer for replacement than for repair (11 days versus 7 days, P = .0001). The mortality rate for patients who underwent repair was 0.00%, compared with 11.18% for those who underwent replacement (P < .05).

Conclusions: The majority of patients with a HOCM diagnosis underwent MV replacement for the correction of MV pathology. Referral to centers with special expertise in treating patients with HOCM may positively affect the operative outcomes of this patient subset.


[AHRQ]Agency for Healthcare Research and Quality. 2010. HCUP quality control procedures. Available at:'> JD, Siewers AE, Finlayson EV, et al. 2002. Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128-37.nBraunwald E. 2009. Hypertrophic cardiomyopathy: the early years. J Cardiovasc Transl Res 2:341-8.nBrown ML, Lenoch JR, Schaff HV. 2010. Variability in data: the Society of Thoracic Surgeons national adult cardiac surgery database. J Thorac Cardiovasc Surg 140:267-73.nCharlson ME, Pompei P, Ales KL, MacKenzie CR. 1987. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373-83.nDeyo RA, Cherkin DC, Ciol MA. 1992. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613-9.nGalloway AC, Colvin SB, Baumann FG, et al. 1989. A comparison of mitral valve reconstruction with mitral valve replacement: intermediateterm results. Ann Thorac Surg 47:655-62.nHCUP]HCUP Databases. 2010. Healthcare Cost and Utilization Project (HCUP). Available at:'> DM, Silverstein T, Lovett AF, Wolf RE, Normand SL. 2007. Comparison of clinical and administrative data sources for hospital coronary artery bypass graft surgery report cards. Circulation 115:1518-27.nVarghese JJ, Koneru S, Scaife SL, Zahnd WE, Francis ML. 2010. Mortality after coronary artery revascularization of patients with rheumatoid arthritis. J Thorac Cardiovasc Surg 140:91-6.nWan CK, Dearani JA, Sundt TM 3rd, Ommen SR, Schaff HV. 2009. What is the best surgical treatment for obstructive hypertrophic cardiomyopathy and degenerative mitral regurgitation? Ann Thorac Surg 88:727-31.nYu EH, Omran AS, Wigle ED, Williams WG, Siu SC, Rakowski H. 2000. Mitral regurgitation in hypertrophic obstructive cardiomyopathy: relationship to obstruction and relief with myectomy. J Am Coll Cardiol 36:2219-25.n



How to Cite

Vassileva, C. M., Boley, T., Markwell, S., & Hazelrigg, S. (2011). Mitral Valve Repair is Underused in Patients with Hypertrophic Obstructive Cardiomyopathy. The Heart Surgery Forum, 14(6), E376-E379.