Pulmonary hypertension adversely affects short- and long-term survival after mitral valve operation for mitral regurgitation: Implications for timing of surgery

Abstract Introduction Diabetes mellitus (DM) represents a notable risk factor after surgical and interventional procedures but data on the influence of DM on long-term survival after Transcatheter Edge-to-edge Repair (TEER) for Mitral valve Regurgitation (MR) are sparse. Purpose To compare the outcome of patients with and without DM after TEER. Methods Retrospective monocentric assessment of patients after successful treatment of MR by TEER (exclusion of combined forms of transcatheter repair) between 06/2010 and 03/2018. Patients were stratified for DM at baseline and observed regarding mortality during follow-up. Cox regression analyses were performed for survival analyses. Results 627 patients (47.0% females, 88.2% aged ≥70 years) and among these 174 subjects with DM (27.3%) were included with a median follow-up period of 486 days [IQR 157–916 days]). Within the investigation period, 20 patients (3.2%) were lost to follow-up. Patients with DM more often presented severe comorbidities like obesity (27.3% vs. 9.2%, p<0.001), arterial hypertension (91.4% vs. 83.7%, p=0.013), renal insufficiency (63.8% vs. 43.9%, p<0.001), coronary artery disease (77.0% vs. 59.8%, p<0.001) or peripheral artery disease (14.4% vs. 8.4%, p=0.026) and had a higher median logistic Euroscore I (29.4% [20.0/43.0] vs. 25.0% [16.7/36.6], p=0.001) as well as reduced systolic function (LVEF 35% [30/50] vs. 45% [30/55], p<0.001). No statistical differences in short- and long-term survival were detected between patients with and without DM (in-hospital mortality 1.7 vs. 2.6%, p=0.771; at 30-days 5.0 vs. 6.0%, p=0.842, 1-year 28.7 vs. 25.0%, p=0.419, 3-years 49.2 vs. 44.1%, p=0.554, 5-years 69.0 vs. 68.3%, p=0.497). By calculating cox regression analyses, DM was not predictive for a higher mortality, even after adjustment for other risk factors (HR 1-year 1.17 [95% CI 0.80–1.71], p=0.419; HR long-term 1.13 [95% CI 0.86–1.49], p=0.373) in the total cohort, as well as after stratification for the underlying mitral valve pathology (functional MR: 1-year HR 0.99 [95% CI 0.01–1.62], p=0.969, long-term HR 0.903 [95% CI 0.63–1.29, p=0.571; primary MR: 1-year HR 1.48 [95% CI 0.66–3.35, p=0.344, long-term HR1.66 [95% CI 0.89–3.09], p=0.110). Conclusions Even though DM-patients presented with a more vulnerable clinical profile, no relevant differences in short- and long-term mortality after TEER for MR were found. Although being factored in most common risk scores, DM could not be associated with an adverse prognosis after transcatheter therapy of MR. FUNDunding Acknowledgement Type of funding sources: None.

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Abstract 2305: Determinants of Outcomes Following Mitral Valve Surgery in Patients with Severe Organic Mitral Regurgitation and No or Mild Symptoms

Circulation ◽

10.1161/circ.118.suppl_18.s_703 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Julien Magne ◽

Patrick Mathieu ◽

François Dagenais ◽

Eric Charbonneau ◽

Jean G Dumesnil ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Surgery ◽

Left Ventricular ◽

Valve Surgery ◽

Left Ventricular Ejection ◽

Term Survival ◽

Long Term Survival ◽

Long Term Mortality

The optimal timing of mitral valve surgery in patients with severe organic mitral regurgitation (OMR) and no or mild symptoms is highly controversial. The aim of this study was thus to determine the preoperative predictors of mortality following mitral valve surgery in patients with severe OMR and no or mild symptoms. Preoperative and operative data of 324 patients (65% of male, mean age: 65±13 years) with severe OMR and no/mild symptoms (NYHA class I and II) who underwent mitral valve surgery between 1992 and 2007 were prospectively collected in a computerized database. Mitral valve repair (MVRp) was performed in 132 (41%) and mitral valve replacement (MVR) in 187 (59%) patients. Operative mortality was low for both procedures (whole cohort: n=9, 2.7%; MVRp: n=2, 1.5%; MVR: n=7, 3.7%; p=0.34) but was significantly higher in the patients (n=167, 56%) with impaired preoperative left ventricular ejection fraction (LVEF) (<60%) (5.3% vs. 1.2%, p=0.04). Long-term survival was 93±2% at 5 years and 87±3% at 10 years. Patients with LVEF<60% had significantly reduced long-term survival compared to patients with normal LVEF (5-year: 89±4% vs. 95±5%, 10-year: 80±6% vs. 88±4%, p=0.049). Multivariate analysis identified age (Hazard-ratio [HR]= 1.03, 95% confidence interval (CI): 1–1.08, p=0.02), heart failure (HR= 1.9, 95%CI: 1.3–3, p= 0.0018), and LVEF (HR= 1.04, 95%CI: 1.01–1.07, p=0.0253) as independent predictors of long-term mortality. Furthermore, MVR was not associated with worse long-term survival on both univariate (p=0.83) and multivariate (p=0.98) analysis. Performing mitral valve surgery is safe in patients with severe OMR and no or mild symptoms. Impaired LVEF is associated with increased short- and long-term mortality, suggesting that these patients should be promptly operated before the onset of LV dysfunction.

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Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation

European Journal of Cardio-Thoracic Surgery ◽

10.1016/s1010-7940(04)00328-8 ◽

2004 ◽

Author(s):

P CHEVALIER

Keyword(s):

Mitral Regurgitation ◽

Perioperative Outcome ◽

Term Survival ◽

Long Term Survival

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Role of Closed Mitral Commissurotomy for Mitral Stenosis: Mid- and Long-term Surgical Outcome of 36 Patients

The Heart Surgery Forum ◽

10.1532/hsf98.20041137 ◽

2005 ◽

Vol 8 (1) ◽

pp. 55 ◽

Cited By ~ 2

Author(s):

Azman Ates ◽

Yahya �nl� ◽

Ibrahim Yekeler ◽

Bilgehan Erkut ◽

Yavuz Balci ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Stenosis ◽

Operating Time ◽

Term Survival ◽

Long Term Outcome ◽

Mitral Commissurotomy ◽

Closed Mitral Commissurotomy

Purpose: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. Material and Methods: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours 30 minutes. Results: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm2. No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade 3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. Conclusions: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.

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Short- and Long-Term Survival of Nonsurgical Intensive Care Patients and its Relation to Diagnosis, Severity of Disease, Age and Comorbidities

Current Aging Science ◽

10.2174/1874609810902030240 ◽

2009 ◽

Vol 2 (3) ◽

pp. 240-248 ◽

Cited By ~ 8

Author(s):

Peter Kaufmann ◽

Karl Smolle ◽

Guenter Krejs

Keyword(s):

Intensive Care ◽

Term Survival ◽

Long Term Survival ◽

Intensive Care Patients ◽

Severity Of Disease ◽

Short And Long Term

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150: Short- and Long-Term Survival of Combined Heart-Kidney Transplants Performed in the United States

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2008.11.828 ◽

2009 ◽

Vol 28 (2) ◽

pp. S118 ◽

Cited By ~ 1

Author(s):

S. Lee ◽

J. Connett ◽

M. Colvin-Adams

Keyword(s):

United States ◽

The United States ◽

Kidney Transplants ◽

Term Survival ◽

Long Term Survival ◽

Short And Long Term

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The Prospects of Secondary Moderate Mitral Regurgitation after Aortic Valve Replacement —Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17197335 ◽

2020 ◽

Vol 17 (19) ◽

pp. 7335

Author(s):

Ilija Bilbija ◽

Milos Matkovic ◽

Marko Cubrilo ◽

Nemanja Aleksic ◽

Jelena Milin Lazovic ◽

...

Keyword(s):

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Meta Analysis ◽

Reverse Remodeling ◽

Term Survival ◽

Long Term Survival

Aortic valve replacement for aortic stenosis represents one of the most frequent surgical procedures on heart valves. These patients often have concomitant mitral regurgitation. To reveal whether the moderate mitral regurgitation will improve after aortic valve replacement alone, we performed a systematic review and meta-analysis. We identified 27 studies with 4452 patients that underwent aortic valve replacement for aortic stenosis and had co-existent mitral regurgitation. Primary end point was the impact of aortic valve replacement on the concomitant mitral regurgitation. Secondary end points were the analysis of the left ventricle reverse remodeling and long-term survival. Our results showed that there was significant improvement in mitral regurgitation postoperatively (RR, 1.65; 95% CI 1.36–2.00; p < 0.00001) with the average decrease of 0.46 (WMD; 95% CI 0.35–0.57; p < 0.00001). The effect is more pronounced in the elderly population. Perioperative mortality was higher (p < 0.0001) and long-term survival significantly worse (p < 0.00001) in patients that had moderate/severe mitral regurgitation preoperatively. We conclude that after aortic valve replacement alone there are fair chances but for only slight improvement in concomitant mitral regurgitation. The secondary moderate mitral regurgitation should be addressed at the time of aortic valve replacement. A more conservative approach should be followed for elderly and high-risk patients.

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