Results of mitral valve surgery for secondary regurgitation with poor left ventricular function

Background and aim: Surgical repair of secondary mitral regurgitation is still controversial especially when the cardiac function is reduced. The purpose of this study was to retrospectively investigate the operative and long-term results of mitral valve surgery for secondary mitral valve regurgitation with poor cardiac function. Risk factors for long-term mortality were also investigated. Methods Patients with preoperative echocardiographic left ventricular ejection fraction ≤30% who underwent mitral valve surgery due to secondary mitral regurgitation comprised the study group. Cardiac function and valve regurgitation was assessed with echocardiogram using modifiled Simpson’s method and color-flow Doppler. Peri-operative results and long-term survival were investigated. Results Sixty-nine patients (mean age 65.5 years, 58 males) with secondary mitral regurgitation and poor left ventricular function comprised the study group, and their early results were investigated; long-term results were evaluated in 66 cases. There were no operative/in-hospital deaths. Postoperative echocardiograms showed significantly improved mitral regurgitation, from moderate to severe to less than trivial (p<0.001), although poor left ventricular function remained. Actual 1-, 3-, and 5-year survival rates were 90.5%, 76.5%, and 63.4%, respectively. The 1-, 3-, and 5-year re-admission-free rates due to heart failure were 74.6%, 61.6%, and 55.3%, respectively. Patients with clinical frailty scale scores ≥4 had a worse prognosis than patients with clinical frailty scale scores <4 (log-rank p=0.046). Conclusions Open mitral valve surgery could be appropriate for secondary mitral valve regurgitation with poor cardiac function, however, operative indications should be considered carefully in patients with high clinical frailty scale scores.

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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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A SYSTEMATIC REVIEW AND META-ANALYSIS OF SURGICAL OUTCOMES FOLLOWING MITRAL VALVE SURGERY IN PATIENTS WITH FUNCTIONAL MITRAL REGURGITATION AND SEVERE LEFT VENTRICULAR DYSFUNCTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)61926-4 ◽

2014 ◽

Vol 63 (12) ◽

pp. A1923

Author(s):

Ali Andalib ◽

Michael Chetrit ◽

Kristian Filion ◽

Christos Gatalas ◽

Darren Mylotte ◽

...

Keyword(s):

Systematic Review ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Ventricular Dysfunction ◽

Meta Analysis ◽

Mitral Valve Surgery ◽

Left Ventricular ◽

Valve Surgery ◽

Functional Mitral Regurgitation ◽

Severe Left Ventricular Dysfunction

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Can We Predict Failure of Mitral Valve Repair?

Journal of Clinical Medicine ◽

10.3390/jcm8040526 ◽

2019 ◽

Vol 8 (4) ◽

pp. 526 ◽

Cited By ~ 2

Author(s):

Simone Gasser ◽

Maria von Stumm ◽

Christoph Sinning ◽

Ulrich Schaefer ◽

Hermann Reichenspurner ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Ejection Fraction ◽

Mitral Valve Repair ◽

Mitral Valve Surgery ◽

Left Ventricular ◽

Valve Surgery ◽

Left Ventricular Ejection ◽

Redo Surgery ◽

Valve Repair

Objective: To identify echocardiographic and surgical risk factors for failure after mitral valve repair. Methods: We identified a total of 77 consecutive patients from our institutional mitral valve surgery database who required redo mitral valve surgery due to recurrence of mitral regurgitation after primary mitral valve repair. A control group of 138 patients who had a stable echocardiographic long-term result was included based on propensity score matching. Systematic analysis of echocardiographic parameters was performed before primary surgery; after mitral valve repair and prior to redo surgery. Risk factor analysis was performed using multivariate Cox regression model. Results: Redo surgery was associated with the presence of pulmonary hypertension ≥ 50 mmHg (p = 0.02), a mean transmitral gradient > 5 mmHg (p = 0.001), left ventricular ejection fraction ≤ 45% (p = 0.05) before surgery and mitral regurgitation ≥moderate at time of discharge (p = 0.002) in the whole cohort. Patients with functional mitral valve regurgitation had a higher tendency to undergo redo surgery if preoperative left ventricular end-diastolic diameter exceeded 65 mm (p = 0.043) and if postoperative tenting height exceeded 6 mm (p = 0.018). Low ejection fraction was not significantly associated with the need for redo mitral valve surgery in the functional subgroup. Conclusions: Recurrent mitral regurgitation is still a valuable problem and is associated with relevant perioperative mortality. Patients with severe mitral regurgitation should undergo early mitral valve repair surgery as long as systolic pulmonary artery pressure is low, left ventricular ejection fraction is preserved, and LVEED is deceeds 65 mm.

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