Textbook Outcome in Mitral Valve Surgery—Results from the Netherlands Heart Registration

A Netherlands Heart Registry study conducted from 2013 to 2021 involving 3,026 patients undergoing primary elective mitral valve surgery evaluated the textbook outcome (TO), defined as the absence of major complications (respiratory insufficiency, prolonged intubation, intensive care unit [ICU] readmission, stroke, renal failure, vascular complications, mediastinitis, reintervention for bleeding) plus survival and no reintervention at one year. The TO was achieved in 87.1 percent of patients. Independent predictors of non-TO included age, reduced left ventricular ejection fraction (LVEF) of less than 50 percent, pulmonary hypertension, recent myocardial infarction (MI), valve replacement vs repair, sternotomy approach, and rhythm surgery. The authors concluded that the TO represents a clinically relevant benchmark for surgical performance evaluation.