Supplement Tables

Table e1. Baseline Patient Characteristics

 MAC

(n = 9,551)No MAC

(n = 43,265)Variable P-

ValueStd Diff

DemographicsAge, yrs 69.2 (11.7) 62.1 (14.3) ≤0.001 0.54Age: 75-84 yrs 3,09

0(32.4) 8,037 (18.6) ≤0.001 0.33

Age: 85+ yrs 482 (5.0) 996 (2.3) ≤0.001Female sex 6,37

2(66.7) 25,233 (58.3) ≤0.001 -0.14

Region 0.001East Central 611 (6.4) 3,762 (8.7)Great Lakes 1,53

5(16.1) 7,381 (17.1)

Mid-Atlantic 1,750

(18.4) 6,843 (15.8)

Mountain 638 (6.7) 2,918 (6.7)New England 481 (5.0) 2,449 (5.7)

Pacific 1,169

(12.3) 4,940 (11.4)

Plains 722 (7.6) 3,192 (7.4)South Atlantic 1,95

0(20.5) 8,488 (19.6)

West Central 695 (7.3) 3,292 (7.6)Hospital volume (MV cases/year)

≤0.0001

10-20 879 (9.2) 3,451 (8.0)21-50 3,05

4(32.1) 14,303 (33.1)

51-100 2,540

(26.7) 12,322 (28.5)

101-200 1,854

(19.5) 9,904 (22.9)

>200 1,224

(12.8) 3,285 (7.6)

Risk Factors and Comorbidities

Dyslipidemia 6,566

(68.7) 25,184 (58.2) ≤0.001 0.18

Diabetes 2,848

(29.8) 9,955 (23.0) ≤0.001 0.12

Hypertension 7,738

(81.0) 30,953 (71.5) ≤0.001 0.20

Chronic Kidney Disease 860 (9.0) 3,321 (7.7) ≤0.001 0.04

1

Dialysis dependent 579 (6.1) 1,959 (4.5) ≤0.001 0.05Liver disease 486 (5.1) 2,845 (6.6) 0.001 -0.05History of Mediastinal

Radiation283 (3.0) 770 (1.8) ≤0.001 0.07

Immunosuppressed 639 (6.7) 2,510 (5.8) 0.001 0.03Peripheral vascular

disease1,07

7(11.3) 3,345 (7.7) ≤0.001 0.10

Cerebrovascular disease 2,098

(22.0) 8,830 (20.4) 0.001 0.03

Previous stroke 1,159

(12.1) 6,018 (13.9) ≤0.001 -0.04

Atrial fibrillation 2,221

(23.3) 9,114 (21.1) ≤0.001 0.04

Endocarditis 611 (6.4) 8,082 (18.7) ≤0.001 0.33CHF within 2 weeks 5,92

6(62.0) 25,525 (59.0) ≤0.001 0.05

NYHA class III/IV 4,338

(45.4) 18,352 (42.4) ≤0.001 -0.03

Ejection fraction (%) 60 (52, 64)

58 (50, 63) 0.001 0.13

STS PROM 6.24 (6.51) 5.18 (6.30) ≤0.001 0.17

Abbreviations: MV - Mitral Valve; CHF - Congestive Heart Failure; NYHA - New York Heart Association; STS PROM - Society of Thoracic Surgeons Predicted Risk of Mortality score; Std Diff – Standardized differences-Continuous variables are presented as mean (SD) or median (IQR) if non-normally distributed; categorical variables are summarized as n (%)*P-value ≤ 0.05 was considered statistically significant.

2

Table e2. Multivariable Logistic Regression for Operative Mortality in Patients Undergoing Mitral Valve Replacement

  Odds Ratio  Variable [95% Confidence Interval] P-ValueMAC 1.24 [1.08-1.42] 0.001Mediastinal radiation therapy 1.85 [1.36-2.54] 0.001Emergent procedure 1.53 [1.19-1.97] 0.001Immunosuppressive therapy 1.47 [1.21-1.78] 0.001Concomitant TV procedure 1.33 [1.16-1.52] 0.001Chronic kidney disease 1.28 [1.12-1.44] 0.006Diabetes 1.27 [1.12-1.44] 0.001Surgical volume <50/yr 1.21 [1.07-1.37] 0.001Symptoms of CHF within 2 weeks 1.17 [1.03-1.34] 0.002Female gender 1.15 [1.00-1.32] 0.01Previous sternotomy 1.11 [1.00-1.26] 0.035

Abbreviations: CHF – Congestive heart failure; TV – Tricuspid valveFull variables tested: - Categorical forced: year of surgery, adult cardiac surgery database version.- Forward stepwise variables: MAC, gender, race, Family history of CAD, smoking status, diabetes, hypertension, hypercholesterolemia, CKD, dialysis, endocarditis, moderate or severe chronic lung disease, IV drug abuse, systemic immunosuppressants, PVD, history of mediastinal radiation, CVD, CVA, History of MI, CHF <2 weeks, history of AF, reoperative status, concomitant TV, preoperative IABP, emergent or urgent operative status, cardiogenic shock, hospital volume <50/year. - Continuous variables: age (years), BMI, BSA, preop WBC, Hematocrit, Platelets, Creatinine, INR, and ejection fraction (%)

3

Figure e1: Kaplan-Meier analysis of time to discharge alive between MAC and non-MAC patients, using operative mortality as competing risk. Patients with operative mortality were

censored at the date of death. The percent of patients remaining alive in-house alive at 7, 15,

and 30 days in the non-MAC group was 66.5 (66.1 – 67.0), 27.1 (26.7 – 27.5) and 8.6 (8.4 –

8.9) and 67.7 (66.7-68.6), 25.8 (24.9 – 26.7), and 8.0 (7.4 – 8.6) for the MAC group.

4

Figure e2: Kaplan-Meier analysis of operative mortality between hospital performing <50 and >=50 MV cases per year

5

6