The lottery of mitral valve repair surgery.

Valve repair, where feasible, rather than valve replacement is the guideline recommended treatment for severe mitral regurgitation. To characterise 'real-world' clinical practice data were reviewed on 12,255 mitral valve operations performed in the UK between 2004 and 2008, as reported in the 2009 UK Adult Cardiac Surgical Database Report. The data demonstrate a large variation in the use of mitral valve repair; while the national repair rate was 51%, this varied from 20% to 90% among different hospitals. Outcomes were worse in patients who had valve replacement as opposed to repair, including a higher risk of operative mortality and stroke, in all subgroups examined. Some patients were, by virtue of the hospitals they attend, therefore, less likely to survive and more likely to have complications, because of a low use of valve repair in those centres. Concentration of mitral valve surgery in designated regional reference centres should allow more equitable access to mitral valve repair.